Spectrum of fungal keratitis: clinicopathologic study of 44 cases

AIM: To determine the causative agents of fungal keratitis and study the predisposing factors over a period of ten years in a single tertiary care hospital. ·METHODS: A retrospective analysis of fungal corneal ulcers was done from 2003-2012. Patients’ clinical data were noted from the file records. Correlation of histopathological diagnosis was done with the report on fungal culture. · RESULTS: Mycotic keratitis was established in 44 cases by a positive fungal culture. Direct microscopic examination of potassium hydroxide(KOH) mounts revealed fungal elements in 39 cases while 40 cases showed fungus on Gram stained smears. Males(54.55%) were more commonly affected than the females(45.45%). The age ranged from 18 to 82 years. Most common age group to be involved was 41-60 years. Predisposing risk factors were seen in 34(77.27%) cases. Most common findings on clinical examination were anterior chamber reaction and conjunctival injection seen in all the cases. Other common findings were stromal infiltration and hypopyon seen in 20(45.45%) and 18(40.91%) cases respectively. On histopathological examination the fungus was typed,as aspergillus in 34 cases while no definite typing was possible in 10 cases. The predominant isolate was aspergillus flavus(59.09%) followed by fusarium(15.91%). Mixed fungal and bacterial infection was seen in 3(6.82%) cases. ·CONCLUSION: Although culture is the gold standard for definitive diagnosis of fungal keratitis,direct microscopic examination of corneal scrapings or histomorphological evaluation of biopsies allow a rapidpreliminary diagnosis. Early administration of antifungal treatment helps in preventing dreadful complications.

Concurrent Nimotuzumab with Radiation Therapy in Locally Advanced Cancers of Oropharynx and Hypopharynx: A Review of 6 Cases

Background: The prevalence of head and neck cancers in the world is around 57% and predominantly occurs in Asian countries. It accounts for 30% of all cancers in India. The cure rate of locally advanced squamous cell carcinoma of the head and neck (SCCHN) has only 30% - 60% even after combined therapeutic approaches. Epidermal Growth Factor Receptor (EGFR) antagonists are the most researched targets in the management of head and neck cancers. Claims at superior tumor control and additional survival benefit without any added toxicity make it an attractive option. With this case series we intend to see how nimotuzumab, a humanized monoclonal antibody, fares in difficult cases of head and neck cancers. Case Description: In this case series, total six patients of locally advanced cancer of head and neck region were treated weekly using cisplatin and nimotuzumab concurrently with radiation therapy (RT) for 6 - 7 weeks. Depending upon the disease stage as well as the general condition of the patient, different dose cycles and radiation doses were tailored. Patients were monitored for regular physical examinations and hematological tests followed by pre and post treatment computed tomography (CT) scans, Fludeoxyglucose positive emission tomography (FDG PET-CT) scans, and histopathology. All patients were assessed for toxicities and managed consequently. After completion of radiation and follow-up, 6 weeks later post treatment CT scans were carried out. Conclusion: This case series shows that combination of chemoradiation with nimotuzumab achieved good response rates with no evidence of residual disease/disease progression on follow-up. The patients’ tolerability with combination therapy was good and toxicity was acceptable. Nimotuzumab was found beneficial in combination with chemoradiation for locally advanced head and neck cancers.

Evaluating the Importance of Apoptotic Index, Mitotic Index and Turnover Index in Premalignant and Malignant Lesions of Cervix

Aim: To evaluate the premalignant and malignant lesions of the uterine cervix on light microscopy for apoptosis. To calculate and correlate the apoptotic index (AI), mitotic index (MI) and turnover index of the lesions. Materials and methods: A 2-year retrospective (November 2007 to October 2009) and 1-year prospective study (November 2009 to October 2010). A total of 95 cases of premalignant and malignant lesions of cervix were studied. The hematoxylin-eosin stained slides were screened for apoptosis under oil immersion lens. Apoptotic index (AI) was calculated as the number of Apoptotic cells and Apoptotic bodies, expressed as percentage of total no. of tumour cells counted in each case. Mitotic index (MI) was calculated by counting mitosis among 1000 tumour cells. Turnover index (TOI) was obtained by adding MI and AI, i.e., (TOI = MI + AI). After calculating, all these indices were correlated with different grades of the cervical lesions. Results: Premalignant lesions were divided into four subgroups. On statistical analysis, it was found that the difference in the apoptotic indices and turnover indices in all the four subgroups was not statistically significant. However for mitotic indices, significant statistical difference was found in Subgroup II (mild dysplasia vs. moderate dysplasia) with a p value of 0.03 and in subgroup IV (squamous metaplasia vs. moderate/severe dysplasia) with a p value of 0.0005. Within the malignant group, we compared well differentiated with less well differentiated subgroup. Statistical analysis revealed a significant difference in TOI between the two subgroups of malignant tumours (p = 0.04). Statistical comparison between premalignant and malignant group of lesions showed a highly significant difference between the AI, MI and TOI with p value of 0.0001. Conclusion: We conclude that proliferative and apoptotic indices are useful in distinguishing between benign and malignant lesions of the cervix. Proliferative activity of a lesion is a reliable indicator of its malignant potential and together with apoptotic count gives an idea about the net growth of a tumour.