Prospective Study of the Diagnostic Accuracy of the In Vivo Laser Scanning Confocal Microscope for Severe Microbial Keratitis.

To determine the diagnostic accuracy of in vivo confocal microscopy (IVCM) for moderate to severe microbial keratitis (MK). Double-masked prospective cohort study. Consecutive patients presenting to Aravind Eye Hospital, Madurai, India, between February 2012 and February 2013 with MK (diameter ≥3 mm, excluding descemetocele, perforation, or herpetic keratitis). Following examination, the corneal ulcer was scanned by IVCM (HRT3/RCM, Heidelberg Engineering, Heidelberg, Germany). Images were graded for the presence or absence of fungal hyphae or Acanthamoeba cysts by the confocal microscopist who performed the scan (masked to microbial diagnosis) and 4 other experienced confocal graders (masked to clinical features and microbiology). The regrading of the shuffled image set was performed by 3 graders, 3 weeks later. Corneal-scrape samples were collected for microscopy and culture. The main outcome measures were sensitivity, specificity, and positive and negative predictive values of IVCM compared with those of a reference standard of positive culture or light microscopy. Sensitivities and specificities for multiple graders were pooled and 95% confidence intervals calculated using a bivariate random-effects regression model. The study enrolled 239 patients with MK. Fungal infection was detected in 176 (74%) and Acanthamoeba in 17 (7%) by microbiological methods. IVCM had an overall pooled (5 graders) sensitivity of 85.7% (95% confidence interval [CI]: 82.2%-88.6%) and pooled specificity of 81.4% (95% CI: 76.0%-85.9%) for fungal filament detection. For Acanthamoeba, the pooled sensitivity was 88.2% (95% CI: 76.2%-94.6%) and pooled specificity was 98.2% (95% CI: 94.9%-99.3%). Intergrader agreement was good: κ was 0.88 for definite fungus; κ was 0.72 for definite Acanthamoeba. Intragrader repeatability was high for both definite fungus (κ: 0.88-0.95) and definite Acanthamoeba classification (κ: 0.63-0.90). IVCM images from 11 patients were considered by all 5 graders to have a specific organism present (10 fungus, 1 Acanthamoeba) but had negative results via culture and light microscopy. Laser scanning IVCM performed with experienced confocal graders has high sensitivity, specificity, and test reproducibility for detecting fungal filaments and Acanthamoeba cysts in moderate to large corneal ulcers in India. This imaging modality was particularly useful for detecting organisms in deep ulcers in which culture and light microscopy results were negative

Corticosteroids for bacterial corneal ulcers.

AIMS: The aim of the study was to conduct a preliminary clinical trial to assess whether adjunctive topical corticosteroids improve outcomes in bacterial keratitis and, if no difference was found, to determine the feasibility and sample size necessary for conducting a larger trial to answer this question. METHODS: In this single centre, double-masked clinical trial, 42 patients with culture-confirmed bacterial keratitis at Aravind Eye Hospital in India were randomised to receive either topical prednisolone phosphate or placebo. All patients received topical moxifloxacin. The primary outcome was best spectacle-corrected visual acuity (BSCVA) at 3 months, adjusting for enrolment BSCVA and arm. Other pre-specified outcomes included re-epithelialisation time, infiltrate/scar size and adverse events. RESULTS: Compared with placebo, patients in the steroid group re-epithelialised more slowly (hazard ratio 0.47, 95% CI 0.23 to 0.94). There was no significant difference in BSCVA or infiltrate/scar size at 3 weeks or 3 months. To have 80% power to detect a two-line difference in acuity, 360 cases would be required. CONCLUSIONS: Although corticosteroid treatment resulted in a statistically significant delay in re-epithelialisation, this did not translate to a significant difference in visual acuity, infiltrate/scar size or adverse events. To assess the effect of steroids on acuity, a larger trial is warranted and feasible

Environmental hydrogeochemistry and genesis of fluoride in groundwaters of Dindigul district, Tamilnadu (India)

Fluoride (F-) is an indispensable element for the human’s skeletal and dental health at prescribed levels and becomes lethal at higher levels. Spatial–temporal variability of F- and its geochemical control/association with other dissolved ions in groundwater in the Dindigul district of Tamilnadu (India) were conducted to describe the geochemical dynamics of F– in response to seasonal variability. High concentrations of fluoride (≥1.5 mg L-1) were observed in the northern region of the district. High levels of F- were observed in non-monsoon periods and low levels in monsoon, because of dilution by precipitation. Bicarbonate was well correlated with F- which explains that both ions were derived from the weathering. While F- has a very weak correlation with silica, this implies that the silicate weathering does not supply F- to the groundwater system. The F- pollution in Dindigul groundwaters is mainly driven by two factors: (1) the geogenic weathering inputs, the geology of this area mainly comprises fluoride bearing minerals (e.g. hornblende biotite gneiss and charnockite); (2) the anthropogenic inputs (agri-fertilizers and tannery waste). Further, F- in the study area is mainly attributed to geogenic sources during pre and postmonsoons and anthropogenic sources in monsoon periods

A study on the status of fluoride ion in groundwater of coastal hard rock aquifers of south India

India has an increasing incidence of fluorosis, dental and skeletal, with nearly about 62 million people at risk. High fluoride groundwaters are present especially in the hard rock areas of the country. This paper analyzes the most extensive database on fluoride and other chemical constituent distribution in the coastal hard rock aquifers of Thoothukudi district. A total of 135 samples were collected and analyzed for major cations and anions to assess the geochemical process. The fluoride concentration in drinking waters varied from BDL to 3.2 mg l-1 in the study area. Majority of the samples do not comply with WHO standards for most of the water quality parameters. The saturation index of fluorite saturation index was used to correlate with F- to identify their relationship to increase of fluoride levels. The correlation between the F- concentration and the water type was also attempted. Spatial distribution of fluoride in groundwater was studied to understand the influencing factors. The relationship of F- with HCO- 3, Na+ and pH concentrations were studied and found that HCO- 3, has good correlation with F- than the other parameters