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Theileria annulata (T. annulata) is a tick-borne apicomplexan parasite that affects bovine. It is endemic in many tropical and subtropics areas, including Odisha, India. The objective of this study is to identify T. annulata infection in the peripheral blood of cattle as a biological sample by conventional PCR (cPCR) and quantitative PCR (qPCR). The phylogenetic analysis was done using the T. annulata merozoite surface antigen (Tams 1) gene. Out of 552 samples of examined blood smears by microscopy, 454 (82.24%) animals were positive for Theileria species. Out of 454 samples, 96 samples were further examined by both cPCR and qPCR, 52 samples (54.16%) were found positive for T. annulata in both PCR methodologies. Phylogenetic analysis revealed that T. annulata Odisha isolate was closely related to T. annulata Uttarakhand, India isolate (KM061799) and Hyderabad, India isolate (MK034702) with Nucleotide sequence identity 95.36%, 95.25%, respectively. This is the first study to detect T. annulata by qPCR in Odisha and supported that both PCR techniques were equally effective for the detection of Tams 1 gene of T. annulata in cattle’s blood.

Background and Aim: Periodontitis is the most prevalent inflammatory dental disease caused by a lack of oral hygiene measures in domestic animals. The periodontal disease complex arises as a result of bacterial biofilm deposition termed as plaque on the tooth surface. Lack of cleaning measures either mechanical or chemical credit for the condition. The present study was conducted to screen the animals for the presence of plaque deposition, gingivitis, along with various control measures for the same. Materials and Methods: Thirty-two dogs of different age groups were evaluated for the presence of plaque and gingivitis by scoring method to estimate the extent of severity. Scaling of the tooth surface was done by ultrasonic scaling machine to remove the plaques, and the animals were divided into four treatment groups to study the effects of dental hygiene chew and chlorhexidine for control of plaque. Results: Present study revealed 71.87% and 34.37% of the screened animals were having plaque deposition and varied degrees of gingivitis respectively. A positive coefficient of correlation (r) of 0.89 (p

Lumpy skin disease virus (LSDV) is the causative agent of lumpy skin disease (LSD) which is a member of Capripoxvirus. It is an economically critical transboundary disease affecting cattle. This study records the first LSD incidence in cattle of Ganjam district and analyses data from LSD outbreak in August 2020 on epidemiological and genetic characterization. Out of 452 animals clinically examined (59 farms), 63 animals were clinically affected with LSD, with a total morbidity rate of 13.93%. The morbidity rates in the villages (ten villages) varied from 5.55 to 21.62%. The multivariable logistic regression showed that grazing of animals (P=0.023; OR: 1.90; 95% CI: 1.09-3.32), and lactation and pregnancy status of animals (P=0.007; OR: 2.86; 95% CI: 1.32-6.17) were the potential risk factors for the occurrence of lumpy skin disease. Out of 53 clinically suspected animals collected from Ganjam district of Odisha, 18 samples (33.96%) were found positive by PCR for both P32 and F genes of capripox virus. Phylogenetic analysis of P32 gene of LSD (MW147486) showed 100% similarity with other isolates from India, Bangladesh, Egypt and Saudi Arabia. Additionally, phylogenetic analysis of F gene of LSD (MW147485) revealed a similarity of 97.99 %, 97.36%, and 96.60% with, Odisha India (MT074110), Beni Suif Egypt (MN694826) and Marsa Matrouh Egypt (MN699855), respectively.

Theileria annulata (T. annulata) is a tick-borne apicomplexan parasite that affects bovine. It is endemic in many tropical and subtropics areas, including Odisha, India. The objective of this study is to identify T. annulata infection in the peripheral blood of cattle as a biological sample by conventional PCR (cPCR) and quantitative PCR (qPCR). The phylogenetic analysis was done using the T. annulata merozoite surface antigen (Tams 1) gene. Out of 552 samples of examined blood smears by microscopy, 454 (82.24%) animals were positive for Theileria species. Out of 454 samples, 96 samples were further examined by both cPCR and qPCR, 52 samples (54.16%) were found positive for T. annulata in both PCR methodologies. Phylogenetic analysis revealed that T. annulata Odisha isolate was closely related to T. annulata Uttarakhand, India isolate (KM061799) and Hyderabad, India isolate (MK034702) with Nucleotide sequence identity 95.36%, 95.25%, respectively. This is the first study to detect T. annulata by qPCR in Odisha and supported that both PCR techniques were equally effective for the detection of Tams 1 gene of T. annulata in cattle’s blood. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (10.1007/s12639-020-01278-6) contains supplementary material, which is available to authorized users.

IMPORTANCE: Antifungal resistance has been shown to impact treatment success, but research analyzing antifungal resistance is scarce. OBJECTIVE: To evaluate changes in antifungal resistance over time. DESIGN, SETTING, AND PARTICIPANTS: Ad hoc analysis of 3 randomized clinical trials including consecutive patients 18 years and older presenting with smear-positive fungal ulcers to Aravind Eye Hospitals in Madurai, Coimbatore, Pondicherry, and Tirunelveli in South India who participated in 1 of 3 clinical trials: the Mycotic Ulcer Treatment Trials (MUTT) I (2010 to 2011) or II (2010 to 2015) or the Cross-Linking Assisted Infection Reduction (CLAIR) trial (2016 to 2018). This post hoc analysis was designed in March 2021 and data were analyzed in May and November 2021. INTERVENTIONS: Minimum inhibitory concentration (MIC) of natamycin and voriconazole was determined from corneal cultures obtained using standardized methods outlined in the Clinical and Laboratory Standards Institute. MAIN OUTCOMES AND MEASURES: The primary outcome of this post hoc analysis was MIC of natamycin and voriconazole. RESULTS: A total of 890 fungal isolates were obtained from 651 patients (mean [SD] age, 49.6 [13.0]; 191 [43.3%] female) from 2010 to 2018. MICs were available for 522 samples in 446 patients. Fungal isolates overall demonstrated a 1.02-fold increase per year in voriconazole resistance as measured by MICs (95% CI, 1.00-1.04; P = .06). In subgroup analyses, Fusarium species demonstrated a 1.04-fold increase in voriconazole resistance per year (95% CI, 1.00-1.06; P = .01). Fungal isolates showed a 1.06-fold increase in natamycin resistance per year overall (95% CI, 1.03-1.09; P

Importance Corneal opacity is a leading cause of visual impairment worldwide; however, the specific features of corneal scars, which decrease visual acuity, have not been well characterized. Objective To investigate which features of a postfungal keratitis corneal scar contribute to decreased visual acuity after an episode of infectious keratitis and evaluate whether any corneal features may be used as outcomes for clinical trials. Design, Setting, and Participants In this ancillary, prospective cross-sectional study, a subset of study participants treated for fungal keratitis (n = 71) as part of the Mycotic Ulcer Treatment Trial I (MUTT I) underwent best spectacle-corrected visual acuity (BSCVA) and best contact lens–corrected visual acuity examination, Scheimpflug imaging, and anterior segment optical coherence tomography at a referral hospital in India approximately 2 years after enrollment. Data were collected from December 3, 2012, to December 19, 2012, and analyses were performed from December 2, 2013, to October 2, 2019. Main Outcomes and Measures Linear regression models were used to evaluate the importance of various corneal features for BSCVA and to assess whether these features could be used to differentiate the 2 treatment arms of the MUTT I trial. Results Seventy-one patients (42 men [59.1%]; median age, 48 [range, 39-60] years) were examined at a median (IQR) time of 1.8 (1.4-2.2) years after enrollment. The mean (SD) logMAR BSCVA was 0.17 (0.19) (Snellen equivalent, 20/32). In multivariable linear regression models, BSCVA was most associated with irregular astigmatism (1.0 line of worse BSCVA per 1-line difference between BSCVA and contact lens visual acuity; 95% CI, 0.6-1.4) and corneal scar density (1.5 lines of worse vision per 10-unit increase in the mean central corneal density; 95% CI, 0.8-2.3). The thinnest point of the cornea was the metric that best discriminated between the natamycin- and voriconazole-treated ulcers in MUTT I, with 29.3 μm (95% CI, 7.1-51.6 μm) less thinning in natamycin-treated eyes. Conclusions and Relevance Both irregular astigmatism and corneal scar density may be important risk factors for BSCVA in a population with relatively mild, healed fungal corneal ulcers. The thinnest point of the corneal scar may be a cornea-specific outcome that could be used to evaluate treatments for corneal ulcers.

Objective To compare oral voriconazole vs placebo in addition to topical antifungals in the treatment of filamentous fungal keratitis. Design Non-prespecified, secondary case-control analysis from a multicenter, double-masked, randomized placebo-controlled clinical trial. Methods Study Participants : Patients with smear-positive filamentous fungal ulcers and visual acuity of 20/400 or worse who eventuated to therapeutic penetrating keratoplasty (TPK). Intervention : Study participants were randomized to oral voriconazole vs oral placebo; all received topical antifungal drops. Main Outcome Measures : TPK button culture positivity. Results A total of 95 of 194 (49.5%) study participants enrolled at Madurai, Coimbatore, or Pondicherry, India eventuated to TPK in an average of 20.9 days (standard deviation 15.2 days, range 2-71 days). TPK button cultures were available for 67 of 95 (71%) of the TPKs performed and were positive for filamentous fungus in 45 of 67 (67%) cases. For each 1-day increase in the time to TPK there was 0.94-fold decreased odds of fungal culture positivity (95% confidence interval [CI] 0.90–0.98, P = .005). Those randomized to oral voriconazole had 1.26-fold increased odds of TPK button culture positivity after controlling for time to TPK and baseline organism, but this was not statistically significant (95% CI 0.32–4.87; P = .74). Those who underwent TPK for lack of response to medical therapy were 10.64-fold more likely to be culture positive than if the indication for surgery was perforation and this was statistically significant (95% CI 2.16–51.70; P = .003). Conclusions There appears to be no benefit to adding oral voriconazole to topical antifungal agents in the treatment of severe filamentous fungal ulcers. Infection rather than inflammation appears to be the reason for the worsening clinical picture in many of these patients.

Purpose To identify fungal keratitis patients who are at risk of a poor outcome and may benefit from closer follow-up or more aggressive treatment. Design Secondary analysis of randomized clinical trial data. Methods We compared the clinical outcomes of patients who had positive 6-day fungal cultures with those who did not, using backward stepwise regression with covariates for all baseline clinical characteristics. Subjects : Patients presenting with a smear-positive filamentous fungal ulcer and visual acuity of 20/400 or worse, and who subsequently had a 6-day fungal culture performed at the Aravind Eye Care system (India), Lumbini Eye Hospital (Nepal), or Bharatpur Eye Hospital (Nepal). Main Outcome Measures : The primary outcome is rate of corneal perforation and/or the need for therapeutic penetrating keratoplasty. Secondary outcomes include 3-month best spectacle-corrected visual acuity (BSCVA), 3-month infiltrate and/or scar size, and rate of re-epithelialization. Results Patients who tested positive at their 6-day culture had twice the hazard of experiencing a corneal perforation or the need for therapeutic penetrating keratoplasty (P = .002) than those who tested negative, even after controlling for baseline ulcer characteristics. These patients also had on average 0.26 logMAR lines worse BSCVA at 3 months (P = .001). Culture positivity at day 6 was not a statistically significant predictor of 3-month infiltrate/scar-size (−0.24 mm1; P = .45) or time to re-epithelialization (hazard ratio = .81; P = .31). Conclusions Here we identify a uniquely valuable clinical tool, day 6 culture results, for the treatment of severe fungal keratitis. Risk stratification based on repeat culture positivity is an objective way to assess response to medical therapy and identify patients who are at high risk of a poor clinical outcome. This establishes a new standard of care for severe fungal keratitis management.

Aim The study was designed to evaluate the hemato-biochemical alterations, urinalysis along with histomorphological and histological changes of prostate glands in dogs affected with benign prostatic hyperplasia (BPH) in and around Bhubaneswar, Odisha, India. Materials and methods In toto, 445 dogs presented to the Teaching Veterinary Clinical Complex of the College of Veterinary Sciences and Animal Husbandry, one Government Veterinary Hospital and two pet clinics in and around Bhubaneswar screened for the presence of BPH. Most of the 57 dogs were 6 years and above as reported by the owners. Only 57 dogs found positive for BPH basing on the presence of typical clinical signs subjected for a detailed hemato-biochemical study. Most of the 57 dogs were 6 years and above as reported by the owners. Routine and microscopic urinalyses were done as per the routine procedure. Histomorphological evaluations of prostate glands were done through manual rectal palpation. Histological examinations of prostate tissue sections of two dead dogs were conducted with routine hematoxylin and eosin stain. Results The study revealed about 12.8% (57/445) of dogs was suffering from BPH. Typical clinical signs - such as passing small thin tape-shaped feces, holding tail away from backward, tenesmus, and straining during urination and defecation - were seen in most of the cases. Urine samples of affected dogs were positive for glucose, occult blood, and protein. A significant decrease in lymphocytes and increase in eosinophil counts in dogs with BPH was recorded. Serum biochemical analysis showed a nonsignificant increase in creatinine and blood urea nitrogen with a significant decrease in total protein, albumin, globulin, A:G ratio. Histology of prostate glands collected during postmortem was characterized by fibrosis of prostate gland, and hyperplasia of the acinar epithelium. Conclusions High rate of the prevalence of BPH in dogs poses an alarming condition which if diagnosed at an early stage can certainly prolong the longevity of the dogs.

A 51-year-old immunocompetent male with a history of Fuchs' endothelial dystrophy and immature cataract who underwent Descemet's stripping automated endothelial keratoplasty with intraocular lens implantation in both eyes presented with redness and defective vision of 1-day duration in his left eye. Slit lamp examination revealed coarse superficial punctate lesions with graft edema. He was diagnosed with acute graft rejection and treated with topical steroids. Two days later, symptoms worsened in his left eye with the involvement of his right eye showing a similar clinical picture. An infectious etiology was suspected and in vivo confocal microscopy ordered, which revealed hyperreflective dots, highly suggestive of microsporidial spores. The patient was prescribed topical fluconazole 0.3% in both eyes. This unique presentation of bilateral graft edema following microsporidial keratoconjunctivitis in postgraft patients requires a high index of suspicion as it can be easily be mistaken for and mismanaged as acute graft rejection.

Natural colorants are important alternatives to synthetic colorants. They are considered harmless and positively affect biological activities owing to their antioxidant potential. The present study deals with the assessment of the extraction processes and the effects of pH (1.0, 3.0, and 5.0), extraction media (water and 50% ethanol) and storage condition (ambient and refrigeration) on betacyanin content, color values, as well as degradation kinetics of total betacyanins in red amaranth. Betacyanin content was more stable at higher than at lower pH. The degradation rate constant (K) was higher and the half-life (t(1/2)) was lower at ambient temperature compared to refrigeration temperature. Betacyanin degradation was higher at ambient temperature (30 ± 2 °C) than at refrigeration temperature (4 °C). The pH, storage time, and temperature affected the stability of the color attributes. Therefore, this work suggests that water and lower temperature (4 °C) could be applied to extract more betacyanins from red amaranth and betacyanins might be used as an alternative to synthetic color. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (10.1007/s13197-018-3519-x) contains supplementary material, which is available to authorized users.

Purpose: The purpose of this study is to describe the presenting features, management strategies, and clinical outcome following bee sting injury to the cornea. Methods: Retrospective case series involving 11 eyes of 11 patients with corneal bee sting injuries who presented over a period of 2 years. Nine of these 11 eyes had the presence of intact bee stinger in the cornea, which was removed immediately under an operating microscope and sent for microbiological and histopathological evaluation. The patients were managed as per the individual treatment protocol of the respective treating physicians. Results: Six eyes (54.5%) had a good clinical outcome (best-corrected visual acuity [BCVA] >20/40) with medical therapy alone with no need for surgical intervention. Five eyes (45.5%) had a poor clinical outcome (BCVA

Aim The present study was undertaken to evaluate the ameliorative potential of dried Moringa oleifera fruit powder in fluorosis affected calves reared around the vicinity of aluminium smelter plant. Materials and methods Total 107 calves were screened on the basis of clinical signs and higher plasma fluoride (more than 0.2 ppm) level for evidence of fluorosis. Out of that, 90 samples found positive and from them 18 calves of 6-12 months age group were selected and divided equally into three groups named as Group II, III, and IV. Group II remained as disease control group whereas Group III calves were supplemented with dried M. oleifera fruit powder of 25 g/calve for 60 days. Group IV calves were supplemented with calcium carbonate at 100 mg/kg body weight and boric acid at 10 mg/kg for the same experimental period. Group I consisted of six numbers of healthy calves taken from the non-fluorotic zone, i.e. Bhubaneswar. Plasma fluoride level, hemoglobin (Hb), packed cell volume (PCV), total leukocyte count (TLC), differential count (DC), total erythrocyte count, mean corpuscular volume (MCV), mean corpuscular Hb (MCH), and MCH concentration (MCHC) were estimated on day 0, 30, and 60 of the experiment. Results Supplementation of dried M. oleifera fruit powder to fluorosis affected calves resulted in significant reduction in plasma fluoride level and increase in Hb%, PCV, TLC and altered DC. Similar results were also recorded in calcium+boron group, except PCV and Hb. No significant changes were observed in MCV, MCH, and MCHC values. Conclusion The present study concluded that supplementation of dried M. oleifera fruit powder daily for 60 days has shown protection against chronic fluoride toxicity in calves.

Importance Identifying patients with infectious keratitis who are at risk of experiencing a poor outcome may be useful to allocate resources toward high- risk patients, particularly in resource-poor settings. Objective To determine baseline patient and ulcer characteristics that predict a high risk of developing corneal perforation and/or the need to undergo therapeutic penetrating keratoplasty (TPK). Design, Setting, and Participants This is a secondary analysis of Mycotic Ulcer Treatment Trial II, a multicenter, double-masked, placebo-controlled randomized clinical trial that enrolled 240 patients with smear-positive filamentous fungal corneal ulcers who enrolled between May 2010 and August 2015. Participants had a baseline visual acuity of 20/400 or worse and were randomized to receive oral voriconazole or a placebo (all participants received topical voriconazole, 1%). After 39 participants (16.3%) were enrolled, topical natamycin, 5%, was also added. Main Outcomes and Measures The primary outcome of this secondary analysis was the rate of corneal perforation or the need to undergo TPK. Results The mean (SD) age at enrollment was 49 (13) years, 104 participants (43.3%) were women, and all were of Southeast Asian descent. The presence of hypopyon at baseline indicated 2.28 times the odds of the patient developing corneal perforation and/or needing TPK (95% CI, 1.18-4.40; P = .01). Study participants whose infiltrate involved the posterior one-third had a 71.4% risk of developing corneal perforation and/or needing TPK. For each 1-mm increase in the geometric mean of the infiltrate, there was 1.37 (95% CI, 1.12-1.67; P = .002) increased odds of developing perforation and/or needing TPK. Other clinical features such as visual acuity, baseline culture positivity, type of filamentous fungal organism and duration of symptoms, and demographic characteristics, such as sex and occupation, were not significant predictors in the multivariable regression analysis. Conclusions and Relevance These results suggest that risk stratification from baseline ulcer characteristics can identify those at highest risk for developing corneal perforation and/or needing TPK. Trial Registration clinicaltrials.gov Identifier:NCT00996736

VACTERL association (any three of vertebral, anal, cardiac, tracheo-esophageal, renal/radial and limb defects) and Prune belly syndrome(complete or partial triad of abdominal muscle deficiency, bilateral cryptorchidism and dilated urinary tract) are cngenitalmalformations affecting many body systems. These are derivatives of causally nonspecific disruptive events of the developmental fieldoccuring during early blastogenesis. Many of these cases are sporadic in families without much recurrence. These lesions may be associatedwith other malformations but concurrence of VACTERL with Prune belly syndrome is extremely rare. Routine antenatal checkup and ultrasonography can help in diagnosis of most of them. But, many times a detail autopsy examination is needed to detect the variety of malformations and categorise them into specific syndromes. We describe a rare combination of VCTERL with Prune bellysyndrome and many associated anomalies of a 28 weeks neonate delivered vaginally by a 37 years second gravida.

Co-channel interference is one of the major problems in wireless systems. The effects of co-channel interference in a Nakagami fading channel on the ABER (Average Bit Error Rate) with static nodes are well analyzed. In this paper, we derive the ABER with the presence of mobile nodes. ABER is also derived for mobile systems in the presence of co-channel interference., {"references":["T.S. Rappaport, Wireless Communications: Principles and Practice, Prentice-Hall, Englewood Cliffs, NJ, 1996.","D. C. Cox, \"Co-channel interference considerations in frequency re-use mobile radio,\" IEEE Trans. Commun., vol. COM-30, pp. 135–142, Jan. 1982.","M.K. Simon and M. S. Alouini, Digital Communication over Fading Channels, 2nd ed. New York: Wiley, 2005.","J. H. Winter, \"Optimum combining in digital mobile radio with cochannel interference,\" IEEE J. Select. Areas Commun., vol. SAC-2, pp. 529-539, July 1984.","A. Shah and A. M. Haimovich, \"Performance analysis of optimum combining in wireless communications with Rayleigh fading and cochannel interference,\" IEEE Trans. Commun., vol. 46, pp. 473-479, Apr. 1998.","Y. Yao and A. U. H. Sheikh, \"Investigations into cochannel interference in microcellular mobile radio systems,\" IEEE Trans. Veh. Technol., vol. 41, no. 2, pp. 114–123, May 1992.","V. A. Aalo and J. Zhang, \"On the effect of cochannel interference on average error rates in Nakagami-fading channels,\" IEEE Commun. Lett., Vol. 3, no. 5, pp.136-138, May 1999.","S. Srinivasa and M. Haenggi, \"Distance distributions in finite uniformly random network: theory and applications,\" IEEE Trans. Veh. Technol. vol. 59, no. 2, pp. 940–949, Feb. 2010.","K. Govindan, K. Zeng, and P. Mohapatra, \"Probability density of the received power in mobile networks,\" IEEE Trans. on Wireless Commun., vol. 10, no. 11, pp. 3613–3619, Nov. 2011.\n[10]\tS. M. Mousavi, H.R. Rabiee, M. Moshref and A. Dabirmoghaddam, \"Mobisim: A framework for simulation of mobility models in mobile ad-hoc networks,\" in Proceedings of the Third IEEE International Conference on Wireless and Mobile Computing, Networking and Communications, p.82, October 08-10, 2007. \n[11]\tC. Bettsteller, G. Resta and P. Santi, \"The node distribution of the random waypoint mobility model for wireless ad hoc networks,\" IEEE Trans. Mobile Comput., vol. 2, no.3, pp. 256-269, Jul. 2003. \n[12]\tValentine A. Aalo, Constantine Mukasa and George P. Efthymoglou, \"Effect of Mobility on the Outage and BER Performances of Digital Transmissions over Nakagami-m Fading Channels,\" IEEE Trans. on Vehicular Technology, vol. 65, no.4, April 2016.\n[13]\tI. Gradshteyn and I. M. Ryzhik, Tables of Integrals, Series, and Products, 7th ed. New York: Academic Press, 2000.\n[14]\tM. Abramovitz and I. Stegun, Handbook of Mathematical Functions with Formulas, Graphs, and Mathematical Tables. New York, ISBN 0-486-61272-4: Dover, 1964.\n[15]\tLarry C. Andrew, Special Functions of Mathematics for Engineers, SPIE Press, 1992."]}

A 14-year-old male presented with decreased vision. Slit lamp examination indicated multiple anterior corneal stromal opacities with clear intervening spaces accompanied with superficial subepithelial lines arranged in a quasi-whorl-like fashion bilateral with greater prominence in the right eye. Corneal steepening associated with thinning was noted only in the right eye. Genetic analysis confirmed a mutation suggestive of granular corneal dystrophy. Here, we describe a rare case of an atypical granular dystrophy associated with unilateral keratoconus in a male child.

AIMS: To report trends in antibiotic resistance in cases of bacterial keratitis from a large eye hospital in South India. METHODS: In this retrospective cross-sectional study, the microbiology laboratory records of patients with infectious keratitis diagnosed at an eye hospital in South India from 2002–2013 were reviewed to determine the proportion with antibiotic non-susceptibility. RESULTS: 3685 bacterial isolates had susceptibility testing performed over the 12-year period. The two most common organisms with resistance results were Streptococcus pneumoniae (N=1204) and Pseudomonas aeruginosa (N=894). Antibiotic non-susceptibility was generally uncommon for these two organisms, and no significant trends were detected over the course of the study. In contrast, Staphylococcus aureus (N=211) isolates demonstrated a significant increase in fluoroquinolone non-susceptibility over the 12-year study period. This coincided with a significant increase in methicillin-resistant S. aureus (MRSA) during the study period, though the increase in fluoroquinolone resistance was likewise seen in methicillin-sensitive S. aureus (MSSA). For example, ofloxacin resistance in MSSA increased from 11.1% in 2002 to 66.7% in 2013 (P=0.002). No trends were apparent for the aminoglycocides, cefazolin, or vancomycin, for which in vitro non-susceptibility generally appeared to be low. CONCLUSIONS: Resistance to antibiotics was generally stable for infectious keratitis isolates from a large eye hospital in South India, except for S. aureus, which experienced a significant increase in fluoroquinolone resistance from 2002 to 2013. Fluoroquinolone antibiotics currently have poor in vitro activity against both methicillin-resistant and methicillin-sensitive S. aureus in South India and are therefore not the ideal therapy for Staphylococcal corneal ulcers.

ObjectiveTo assess the trends in microbiological organisms identified from corneal scrapings from patients with infectious keratitis at a tertiary care medical centre in South India.MethodsWe reviewed the records of the microbiology laboratory at Aravind Eye Hospital in Madurai, India, from 2002 until 2012. We identified the microbiological causes of all corneal ulcers from the culture and smear results, and assessed for trends in bacterial and fungal keratitis over time.ResultsOf 23 897 corneal patients with ulcer with a corneal smear from 2002 to 2012 a fungal organism was identified in 34.3%, a bacterial organism in 24.7% and no organism in 38.3%. During this period, the annual number of keratitis cases due to bacteria decreased from 677 to 412, and the annual number due to fungus increased from 609 to 863. In analyses accounting for the total number of outpatients seen each year, the decline in number of smears positive for bacteria was statistically significant (p

Importance Fusarium keratitis is common and often results in poor outcomes. No new treatments since natamycin have become available. Objective To explore the role of adjuvant oral voriconazole on clinical outcomes in Fusarium keratitis. Design, Setting, and Participants In this prespecified subgroup analysis of a multicenter, double-masked, placebo-controlled randomized clinical trial, 240 patients from the Aravind Eye Care System in India, the Lumbini Eye Hospital and Bharatpur Eye Hospital in Nepal, and the University of California, San Francisco, who had culture-positive fungal ulcer and baseline visual acuity of 20/400 or worse were randomized to receive oral voriconazole vs placebo. Enrollment started May 24, 2010, and the last patient study visit was November 23, 2015. All patients received topical voriconazole, 1%, and after the results of the Mycotic Ulcer Treatment Trial (MUTT) II became available, topical natamycin, 5%, was added for all patients. Data analysis was performed from September 2 to October 28, 2016. Main Outcomes and Measures The primary outcome of the trial was the rate of corneal perforation or the need for therapeutic penetrating keratoplasty. Secondary outcomes included rate of reepithelialization, best spectacle-corrected visual acuity, and infiltrate or scar size at 3 months. Results Of the 240 study participants, 72 (30.4%) were culture positive for Fusarium species (41 [56.9%] male and 31 [43.1%] female; median [interquartile range] age, 50 [45-57] years). Of these, 33 (45.8%) were randomized to oral voriconazole and 39 (54.2%) to placebo. Fusarium ulcers randomized to oral voriconazole had a 0.43-fold decreased hazard of perforation or therapeutic penetrating keratoplasty compared with placebo after controlling for baseline infiltrate depth (95% CI, 0.22-fold to 0.84-fold; P = .01). Multiple linear regression revealed a 1.89-mm decreased infiltrate and/or scar size at 3 weeks (95% CI, −2.69 to −1.09 mm; P P = .001) in eyes randomized to oral voriconazole vs placebo. Eyes treated with oral voriconazole also had a mean 0.29 decreased logMAR (improved) (Snellen equivalent 20/40) visual acuity at 3 months after controlling for baseline visual acuity, although this finding was not statistically significant (95% CI, −0.57 to 0.002; P = .052). Conclusions and Relevance Although MUTT II could not find a benefit for all corneal ulcers, Fusarium keratitis may benefit from the addition of oral voriconazole to topical natamycin, and physicians should consider prescribing oral voriconazole in these cases. Trial Registration clinicaltrials.gov Identifier:NCT00996736

Objective To compare oral voriconazole with placebo in addition to topical antifungals in the treatment of filamentous fungal keratitis. Design, Setting, and Participants The Mycotic Ulcer Treatment Trial II (MUTT II), a multicenter, double-masked, placebo-controlled, randomized clinical trial, was conducted in India and Nepal, with 2133 individuals screened for inclusion. Patients with smear-positive filamentous fungal ulcers and visual acuity of 20/400 (logMAR 1.3) or worse were randomized to receive oral voriconazole vs oral placebo; all participants received topical antifungal eyedrops. The study was conducted from May 24, 2010, to November 23, 2015. All trial end points were analyzed on an intent-to-treat basis. Interventions Study participants were randomized to receive oral voriconazole vs oral placebo; a voriconazole loading dose of 400 mg was administered twice daily for 24 hours, followed by a maintenance dose of 200 mg twice daily for 20 days, with dosing altered to weight based during the trial. All participants received topical voriconazole, 1%, and natamycin, 5%. Main Outcomes and Measures The primary outcome of the trial was rate of corneal perforation or the need for therapeutic penetrating keratoplasty (TPK) within 3 months. Secondary outcomes included microbiologic cure at 6 days, rate of re-epithelialization, best-corrected visual acuity and infiltrate and/or scar size at 3 weeks and 3 months, and complication rates associated with voriconazole use. Results A total of 2133 patients in India and Nepal with smear-positive ulcers were screened; of the 787 who were eligible, 240 (30.5%) were enrolled. Of the 119 patients (49.6%) in the oral voriconazole treatment group, 65 were male (54.6%), and the median age was 54 years (interquartile range, 42-62 years). Overall, no difference in the rate of corneal perforation or the need for TPK was determined for oral voriconazole vs placebo (hazard ratio, 0.82; 95% CI, 0.57-1.18;P = .29). In prespecified subgroup analyses comparing treatment effects among organism subgroups, there was some suggestion thatFusariumspecies might have a decreased rate of perforation or TPK in the oral voriconazole-treated arm; however, this was not a statistically significant finding after Holms-Sidak correction for multiple comparisons (effect coefficient, 0.49; 95% CI, 0.26-0.92;P = .03). Patients receiving oral voriconazole experienced a total of 58 adverse events (48.7%) compared with 28 adverse events (23.1%) in the placebo group (P Conclusions and Relevance There appears to be no benefit to adding oral voriconazole to topical antifungal agents in the treatment of severe filamentous fungal ulcers. All patients in this study were enrolled in India and Nepal; therefore, it is possible that organisms in this region may exhibit characteristics different from those in other regions of the world. Trial Registration clinicaltrials.gov Identifier:NCT00996736

Author version made available in accordance with the publisher's policy., A mutation miR-184(+57C>T) in the seed region of miR-184 (encoded by MIR184 [MIM*613146]) results in familial severe keratoconus combined with early-onset anterior polar cataract and endothelial dystrophy, iris hypoplasia, congenital cataract, and stromal thinning (EDICT) syndrome (MIM#614303). In order to investigate the phenotypic spectrum resulting from MIR184 mutation, MIR184 was sequenced in a keratoconus cohort of mixed ethnicity and a Chinese axial myopia cohort. Sequencing of MIR184 was performed in 780 unrelated keratoconus patients and 96 unrelated Han southern Chinese subjects with axial myopia. Effects of identified mutations on RNA secondary structure were predicted computationally using mFold and RNAFold algorithms. MIR184 amplicons from patients harboring mutations were cloned and transfected into human embryonic kidney 293T (HEK293T) cells, and mature mutant miR-184 expression was analyzed by stem-loop real-time quantitative PCR (RT-qPCR). Two novel heterozygous substitution mutations in MIR184 were identified in the two patients with isolated keratoconus: miR-184(+8C>A) and miR-184(+3A>G). Computational modeling predicted that these mutations would alter the miR-184 stem-loop stability and secondary structure. Ex vivo miR-184 expression analysis demonstrated that miR-184(+8C>A) almost completely repressed the expression of miR-184 (P = 0.022), and miR-184(+3A>G) reduced the expression of miR-184 by approximately 40% (P = 0.002). There was no significant association of rs41280052, which lies within the stem-loop of miR-184, with keratoconus. No MIR184 mutations were detected in the axial myopia cohort. Two novel heterozygous substitution mutations in MIR184 were identified in two patients with isolated keratoconus: miR-184(+8C>A) and miR-184(+3A>G). Mutations in MIR184 are a rare cause of keratoconus and were found in 2 of 780 (0.25%) cases., Supported by Fight for Sight (United Kingdom; JL, CEW); The Research and Development Office, Northern Ireland (RRG Grant 4.46; CEW); Biotechnology and Biological Sciences Research Council, United Kingdom (Grant BB/H005498/1; JG-F, DAS); National Health and Medical Research Council of Australia (KPB, JEC); ALCON India (GG, MD, PS); and The Aravind Eye Care System (GG, MD, PS). JL is a Fight for Sight PhD student.

Purpose To determine risk factors and clinical signs that may differentiate between bacterial, fungal, and acanthamoeba keratitis among patients presenting with presumed infectious keratitis. Design Hospital-based cross-sectional study. Methods We examined the medical records of 115 patients with laboratory-proven bacterial keratitis, 115 patients with laboratory-proven fungal keratitis, and 115 patients with laboratory-proven acanthamoeba keratitis seen at Aravind Eye Hospital, Madurai, India, from 2006-2011. Risk factors and clinical features of the 3 organisms were compared using multinomial logistic regression. Results Of 95 patients with bacterial keratitis, 103 patients with fungal keratitis, and 93 patients with acanthamoeba keratitis who had medical records available for review, 287 (99%) did not wear contact lenses. Differentiating features were more common for acanthamoeba keratitis than for bacterial or fungal keratitis. Compared to patients with bacterial or fungal keratitis, patients with acanthamoeba keratitis were more likely to be younger and to have a longer duration of symptoms, and to have a ring infiltrate or disease confined to the epithelium. Conclusions Risk factors and clinical examination findings can be useful for differentiating acanthamoeba keratitis from bacterial and fungal keratitis.

Positive ion electron ionization mass spectra are presented for palladium(II) β-diketonates and monothio-β-diketonates of the general form PdII[RC(X)CHC(O)R′]2, where R = phenyl, 4-methoxyphenyl, 2-thienyl, or 2-naphthyl; R′ = trifluoromethyl, pentafluoroethyl, or n-heptafluoropropyl; and X = O or S. The mass spectral behavior is in sharp contrast to that of metals of the first transition series. The spectra of the β-diketonates are dominated by metal-containing ions that arise by migration of the R group from the ligand (L) to palladium, but there is no evidence for fluorine-to-metal transfer. These findings are consistent with HSAB theory. The strong tendency of palladium to form bonds with unsaturated carbon also leads to remarkably abundant metal-containing ions that arise by losses of CO or aryloxy radicals from [PdRL]+• ions. In contrast, in decompositions of ions in the spectra of the monothio-β-diketonates, migration of the R group is suppressed; competition for palladium dπ electrons by the sulfur donor makes palladium a poorer aryl group acceptor.

Electron ionization positive-ion mass spectra are reported for 18 substituted nickel(II) β-diketonates and monothio-β-diketonates, NiII(RCXCHCOR′)2, where X = O or S; R = phenyl, 2-thienyl, 5-methyl-2-thienyl, or 2-naphthyl; and R′ = difluoromethyl, trifluoromethyl, pentafluoroethyl, or n-heptafluoropropyl. Each mass spectrum contains a prominent molecular ion, [NiL2]+, which, for β-diketonates, fragments mainly by elimination of the odd-electron R′• species; the resulting ion decomposes by losses of one or more even-electron neutral species to yield ions containing nickel(II). In contrast, the major fragmentation of the molecular ion of monothio-β-diketonates is loss of NiIL to yield an abundant L+ ion. Furthermore, while most ions contain nickel(II), some prominent ions contain nickel(I); among these are [NiISC(R) = CH]+ and [NiI(HCCR)]+. Interesting ions are formed by hydrogen transfer processes. The [NiHL]+ ion is favored in the spectra of β-diketonates having a phenyl substituent, consistent with hydrogen transfer to the metal from the aryl group. On the other hand, the [Ni(L–H)]+ ion, favored for the monothio-β-diketonates, could be formed by hydrogen transfer from the central position of the chelate ring or from an aryl substituent. Alternative mechanisms of formation are discussed. Some minor ions are formed by fluorine transfer to nickel. The trends in their abundances are influenced by the hardness of nickel as an acid in its different oxidation states, under the influence of the ligand donor atoms, and by the hardness of the carbon atoms of the perfluoroalkyl substituents.

PURPOSE: To assess the safety and efficacy of Manual Small Incision Cataract Surgery (MSICS) in cases of white cataract with the use of trypan blue as an adjunct for performing continuous curvilinear capsulorthexis (CCC). MATERIALS AND METHODS: Prospective observational study on 100 consecutive eyes of 100 patients with white cataract who had undergone MSICS with trypan blue assisted CCC. The nucleus was prolapsed into anterior chamber by using a sinskey hook and extracted out of the eye using irrigating vectis. Intraoperative and postoperative findings (according to OCTET classification) as well as postoperative visual outcomes were used as main measures to report the safety and efficacy of the surgery. RESULTS: Of the 100 eyes, 16 had intumescent, 67 had mature and 17 had hypermature cataract. Intraoperatively CCC was incomplete in 4 eyes (4%) and had to be converted to canopener capsulotomy. None of the eyes had posterior capsular rupture or zonular dialysis and no eyes were converted to conventional Extra Capsular Cataract Extraction (ECCE). Postoperatively, 6 eyes (6%) developed corneal oedema with >10 Descemets folds and 7 eyes (7%) had corneal oedema with < 10 Descemets folds. Mild iritis was seen in 6 eyes (6%) and moderate iritis with fibrin membrane was seen in 3 eyes (3%). Iridodialysis was observed in 1 eye (1%). Of the 99 patients (99%) categorised under good visual outcomes category, 94 patients (94%) had a best-corrected visual acuity of 6/9 or better on the 40th post-operative day. CONCLUSION: In developing countries like India where phacoemulsification may not be affordable to a majority of those requiring cataract surgery, MSICS proves to be a safe and efficacious alternative for white cataracts especially with the adjunctive use of trypan blue dye.

Background The involvement of VSX1 gene for the genetic basis of keratoconus is unclear and controversial. The genetic screening of VSX1 from different ethnic populations can enlighten this subject. The aim of the present study is to investigate the role of VSX1 gene in patients with sporadic cases of keratoconus from South India. Methods The VSX1 gene coding regions, including exon-intron boundaries were screened by direct sequencing analysis in 117 sporadic cases of keratoconus. The identified variations were also analyzed in 108 ethnic matched healthy blood donors. Results In the VSX 1 gene screening, no pathogenic mutation was identified, whereas we could find the presence of four reported single nucleotide polymorphisms; c.546A>G (rs12480307), c.627+23G>A (rs6138482), c.627+84T>A (rs56157240) and c.504-24C>T (IVS3-24C). These variations were observed in similar frequency between cases and controls. Conclusions The lack of VSX1 pathogenic variations in a large number of unrelated sporadic keratoconus patients tend to omit its role, and corroborate the involvement of other genetic, environmental or behavioural factors in the development of this complex disorder.