Contact examination in leprosy: a success story

Introduction: Leprosy is an infectious disease spread by respiratory droplets. Contact examination ofindex cases is recommended for new case detection and as a disease control measure. Public healthauthorities are entrusted with contact examination.Objectives: We report two interventions carried out at the dermatology clinic Base Hospital Homagamawith good results. We planned to analyze the yield of a hospital based contact examination clinic andto assess the success of public health interventions to find infective cases.Methods: Intervention 1; All new cases registered in 2016 were requested to bring household contactsfor examination. All contacts who presented were examined for skin lesions. All clinically diagnosedcases were started on MDT. All suspicious lesions were biopsied. Intervention 2; 5 new cases of singlelesion tuberculoid leprosy, including 3 children, from the same location were detected. Surveys of theschool where the children studied and a house to house survey were carried out.Results: Intervention 1; There were 110 contacts listed for 32 index cases. Twenty one (21) cases(65.6%) brought 63 contacts for examination. Eleven (11) contacts for 6 index cases (28.9% indexcases) were positive for leprosy. Intervention 2; The house to house survey revealed a case oflepromatous leprosy (BI 6+) living next to the first index case. 3 members of his extended family hadsingle lesion leprosy.Conclusions: Contact examination clinic is a productive method for early case detection. A wellplanned house to house survey would also yield successful results

Cytokine and Protein Markers of Leprosy Reactions in Skin and Nerves: Baseline Results for the North Indian INFIR Cohort

Leprosy affects skin and peripheral nerves. Although we have effective antibiotics to treat the mycobacterial infection, a key part of the disease process is the accompanying inflammation. This can worsen after starting antibacterial treatment with episodes of immune mediated inflammation, so called ‘reactions’. These reactions are associated with worsening of the nerve damage. We recruited a cohort of 303 newly diagnosed leprosy patients in North India with the aim of understanding and defining the pathological processes better. We took skin and nerve biopsies from patients and examined them to define which molecules and mediators of inflammation were present. We found high levels of the cytokines Tumour Necrosis Factor alpha, Transforming Growth Factor beta and inducible Nitric Oxide Synthase in biopsies from patients with reactions. We also found high levels of bacteria and inflammation in the nerves. These experiments tell us that we need to determine which other molecules are present and to explore ways of switching off the production of these pro-inflammatory molecules

Cyclodialysis cleft with late hypotony maculopathy after inadvertent cannula detachment during cataract surgery

Case ReportWe present the case of a 69-year-old woman who presented with hypotony several years after an inadvertent cannula detachment presumably formed a cyclodialysis cleft during phacoemulsification cataract extraction and posterior chamber intraocular lens implantation in her right eye. To our knowledge, this is the first report of late hypotony maculopathy as a result of inadvertent cannula release.Shyalle Kahawita, Sudha Cugati, Robert Casso

Aspirin use and early age-related macular degeneration: a meta-analysis

Objective: The aim of this review was to evaluate the evidence for an association between Aspirin use and early age-related macular degeneration (ARMD). Methods: A literature search was performed in 5 databases with no restrictions on language or date of publication. Four studies involving 10292 individuals examining the association between aspirin and ARMD met the inclusion criteria. Meta-analysis was carried out by Cochrane Collaboration Review Manager 5.2 software (Cochrane Collaboration, Copenhagen, Denmark). Results: The pooled odd ratios showed that Aspirin use was associated with early ARMD (pooled odds ratio 1.43, 95% CI 1.09–1.88). Conclusions: There is a small but statistically significant association between Aspirin use and early ARMD, which may warrant further investigation.Shyalle K.Kahawita, Robert J.Casso

Flashes and floaters: a practical approach to assessment and management

BACKGROUND: Flashes and floaters are common ophthalmic issues for which patients may initially present to their general practitioner. It may be a sign of benign, age-related changes of the vitreous or more serious retinal detachment. OBJECTIVE: This article provides a guide to the assessment and management of a patient presenting with flashes and floaters. DISCUSSION: Although most patients presenting with flashes and floaters have benign age-related changes, they must be referred to an ophthalmologist to rule out sight-threatening conditions. Key examination features include the nature of the flashes and floaters, whether one or both eyes are affected and changes in visual acuity or visual field.Shyalle Kahawita, Sumu Simon, Jolly Gilhotr

Manual small incision extracapsular cataract surgery in Australia

Article first published online: 30 APR 2014Background: Examination of the results and describing the technique of manual small incision extracapsular cataract extraction on patients with advanced cataracts in urban Australia. Design: A descriptive case series. Participants: Thirty-eight patients at three public hospitals, one tertiary and two secondary ophthalmic units in urban Australia. Methods: Forty eyes with dense mature cataracts with hand movement vision or worse underwent a planned manual small incision extracapsular cataract extraction instead of traditional phaco-emulsification. Main Outcome Measures: Postoperative visual aquity, surgically induced astigmatism and complications. Results: Seventy-eight per cent of patients had an uncorrected visual acuity of 6/12 or better on the first postoperative day. Eighty-three per cent of patients had a distance corrected visual acuity of 6/9 or better 3 months postoperatively. One case was complicated by a posterior capsule rupture. No cases of endophthalmitis were reported. The summated vector mean of the surgically induced astigmatism was 0.089D at 93°. Conclusion: Manual small incision extracapsular cataract extraction is an efficacious cataract surgery technique with good visual outcome and is a safe alternative to phaco-emulsification in suitable cases in a first-world setting.Lourens van Zyl, Shyalle Kahawita and Michael Goggi