The binocular alignment of the eyes involves both voluntary and reflexive mechanisms, but little is known about the visual input and neurological pathway of the reflex component. Our studies examined ...the role of spatiotemporal frequency and contrast in the control of reflex eye alignment, and compared the contrast sensitivity of the alignment reflex with psychophysical contrast sensitivity. We measured the contrast sensitivity of vertical disparity-driven vergence eye movements in response to bandwidth filtered static or 6 Hz counterphase flickering noise and measured psychophysical detection sensitivity for the same stimuli. Contrast thresholds for producing a detectable vertical alignment change (measured with nonius lines) were determined using a staircase method for 7 spatial frequencies 0.25-16 cycles per degree and 3 vertical disparities 5, 10, and 30 arcmin in 7 adults with normal or corrected to normal vision. The main findings of this study are, (1) the vertical alignment reflex had overall relatively high contrast sensitivity, comparable to but somewhat less than visual detection thresholds, (2) the most effective stimulus spatial frequency scaled in inverse proportion to the disparity being stimulated, and (3) unlike psychophysical contrast sensitivity, the eye alignment reflex contrast sensitivity was not improved by flickering low spatial frequencies.
Prolong near work, especially among people with uncorrected refractive error is considered a potential source of visual symptoms. The present study aims to determine the visual symptoms and the ...association of those with refractive errors among Thangka artists.
In a descriptive cross-sectional study, 242 (46.1%) participants of 525 thangka artists examined, with age ranged between 16 years to 39 years which comprised of 112 participants with significant refractive errors and 130 absolutely emmetropic participants, were enrolled from six Thangka painting schools. The visual symptoms were assessed using a structured questionnaire consisting of nine items and scoring from 0 to 6 consecutive scales. The eye examination included detailed anterior and posterior segment examination, objective and subjective refraction, and assessment of heterophoria, vergence and accommodation. Symptoms were presented in percentage and median. Variation in distribution of participants and symptoms was analysed using the Kruskal Wallis test for mean, and the correlation with the Pearson correlation coefficient. A significance level of 0.05 was applied for 95% confidence interval. The majority of participants (65.1%) among refractive error group (REG) were above the age of 30 years, with a male predominance (61.6%), compared to the participants in the normal cohort group (NCG), where majority of them (72.3%) were below 30 years of age (72.3%) and female (51.5%).
Overall, the visual symptoms are high among Thangka artists. However, blurred vision (p = 0.003) and dry eye (p = 0.004) are higher among the REG than the NCG. Females have slightly higher symptoms than males. Most of the symptoms, such as sore/aching eye (p = 0.003), feeling dry (p = 0.005) and blurred vision (p = 0.02) are significantly associated with astigmatism.
Thangka artists present with significant proportion of refractive error and visual symptoms, especially among females. The most commonly reported symptoms are blurred vision, dry eye and watering of the eye. The visual symptoms are more correlated with astigmatism.
Background The prevalence of antimicrobial resistance (AMR) among Gram-negative bacteria is alarmingly high. Reintroduction of colistin as last resort treatment in the infections caused by ...drug-resistant Gram-negative bacteria has led to the emergence and spread of colistin resistance. This study was designed to determine the prevalence of drug-resistance among beta-lactamase-producing strains of Escherichia coli and Klebsiella pneumoniae, isolated from the clinical specimens received at a tertiary care centre of Kathmandu, Nepal during the period of March to August, 2019. Methods A total of 3216 different clinical samples were processed in the Microbiology laboratory of Kathmandu Model Hospital. Gram-negative isolates (E. coli and K. pneumoniae) were processed for antimicrobial susceptibility test (AST) by using modified Kirby-Bauer disc diffusion method. Drug-resistant isolates were further screened for extended-spectrum beta-lactamase (ESBL), metallo-beta-lactamase (MBL), carbapenemase and K. pneumoniae carbapenemase (KPC) production tests. All the suspected enzyme producers were processed for phenotypic confirmatory tests. Colistin resistance was determined by minimum inhibitory concentration (MIC) using agar dilution method. Colistin resistant strains were further screened for plasmid-mediated mcr-1 gene using conventional polymerase chain reaction (PCR). Results Among the total samples processed, 16.4% (529/3216) samples had bacterial growth. A total of 583 bacterial isolates were recovered from 529 clinical samples. Among the total isolates, 78.0% (455/583) isolates were Gram-negative bacteria. The most predominant isolate among Gram-negatives was E. coli (66.4%; 302/455) and K. pneumoniae isolates were 9% (41/455). In AST, colistin, polymyxin B and tigecycline were the most effective antibiotics. The overall prevalence of multidrug-resistance (MDR) among both of the isolates was 58.0% (199/343). In the ESBL testing, 41.1% (n = 141) isolates were confirmed as ESBL-producers. The prevalence of ESBL-producing E. coli was 43% (130/302) whereas that of K. pneumoniae was 26.8% (11/41). Similarly, 12.5% (43/343) of the total isolates, 10.9% (33/302) of E. coli and 24.3% of (10/41) K. pneumoniae were resistant to carbapenem. Among 43 carbapenem resistant isolates, 30.2% (13/43) and 60.5% (26/43) were KPC and MBL-producers respectively. KPC-producers isolates of E. coli and K. pneumoniae were 33.3% (11/33) and 20% (2/10) respectively. Similarly, 63.6% (21/33) of the E. coli and 50% (5/10) of the K. pneumoniae were MBL-producers. In MIC assay, 2.2% (4/179) of E. coli and 10% (2/20) of K. pneumoniae isolates were confirmed as colistin resistant (MIC greater than or equai to 4 microg/ml). Overall, the prevalence of colistin resistance was 3.1% (6/199) and acquisition of mcr-1 was 16.6% (3/18) among the E. coli isolates. Conclusion High prevalence of drug-resistance in our study is indicative of a deteriorating situation of AMR. Moreover, significant prevalence of resistant enzymes in our study reinforces their roles in the emergence of drug resistance. Resistance to last resort drug (colistin) and the isolation of mcr-1 indicate further urgency in infection management. Therefore, extensive surveillance, formulation and implementation of effective policies, augmentation of diagnostic facilities and incorporation of antibiotic stewardship programs can be some remedies to cope with this global crisis. Keywords: Escherichia coli, Klebsiella pneumoniae, Colistin resistance, Extended spectrum beta-lactamase, Metallo-beta-lactamase, Klebsiella pneumoniae carbapenemase, Multidrug resistance and plasmid-mediated mcr-1 gene
Efflux-pump system and biofilm formation are two important mechanisms
Pseudomonas aeruginosa
deploys to escape the effects of antibiotics. The current study was undertaken from September 2019 to ...March 2020 at a tertiary-care hospital in Kathmandu in order to ascertain the burden of
P. aeruginosa
in clinical specimens, examine their biofilm-forming ability and determine their antibiotic susceptibility pattern along with the possession of two efflux-pump genes-
mex
A and
mex
B. Altogether 2820 clinical specimens were collected aseptically from the patients attending the hospital and processed according to standard microbiological procedures. Identification of
P. aeruginosa
was done by Gram stain microscopy and an array of biochemical tests. All the
P. aeruginosa
isolates were subjected to
in vitro
antibiotic susceptibility testing and their biofilm-forming ability was also examined. Presence of
mex
A and
mex
B efflux-pump genes was analyzed by Polymerase Chain Reaction (PCR) using specific primers. Out of 603 culture positive isolates, 31 (5.14%) were found to be
P. aeruginosa
, of which 55% were multi-drug resistant (MDR). Out of 13 commonly used antibiotics tested by Kirby-Bauer disc diffusion method, greatest resistance was shown against piperacillin-tazobactam 15 (48.4%) and ceftazidime 15 (48.4%), and least against meropenem 6 (19.4%) and ofloxacin 5 (16.2%). Of all 17 MDR isolates subjected to biofilm detection, strong biofilm formation was exhibited by 11 (65%) and 14 (82%) isolates with microtiter plate method and tube method respectively. Out of 17 isolates tested, 12 (70.6%) isolates possessed
mex
A and
mex
B genes indicating the presence of active efflux-pump system. Higher number of the isolates recovered from sputum 7 (58.3%) and pus 5 (41.7%) possessed
mex
A
/mex
B genes while the genes were not detected at all in the isolates recovered from the urine (p<0.05). This study assessed no significant association between biofilm production and multi-drug resistance (p>0.05). Adoption of stern measures by the concerned authorities to curb the incidence of multi-drug resistant and biofilm-forming isolates is recommended to prevent their dissemination in the hospital settings.
BackgroundConvalescent plasma therapy (CPT) and remdesivir (REM) have been approved for investigational use to treat coronavirus disease 2019 (COVID-19) in Nepal.
MethodsIn this prospective, ...multicentered study, we evaluated the safety and outcomes of treatment with CPT and/or REM in 1315 hospitalized COVID-19 patients over 18 years in 31 hospitals across Nepal. REM was administered to patients with moderate, severe, or life-threatening infection. CPT was administered to patients with severe to life-threatening infections who were at high risk for progression or clinical worsening despite REM. Clinical findings and outcomes were recorded until discharge or death.
ResultsPatients were classified as having moderate (24.2%), severe (64%), or life-threatening (11.7%) COVID-19 infection. The majority of CPT and CPT + REM recipients had severe to life-threatening infections (CPT 98.3%; CPT + REM 92.1%) and were admitted to the intensive care unit (ICU; CPT 91.8%; CPT + REM 94.6%) compared with those who received REM alone (73.3% and 57.5%, respectively). Of 1083 patients with reported outcomes, 78.4% were discharged and 21.6% died. The discharge rate was 84% for REM (n = 910), 39% for CPT (n = 59), and 54.4% for CPT + REM (n = 114) recipients. In a logistic model comparing death vs discharge and adjusted for age, gender, steroid use, and severity, the predicted margin for discharge was higher for recipients of remdesivir alone (0.82; 95% CI, 0.79–0.84) compared with CPT (0.58; 95% CI, 0.47–0.70) and CPT + REM (0.67; 95% CI, 0.60–0.74) recipients. Adverse events of remdesivir and CPT were reported in <5% of patients.
ConclusionsThis study demonstrates a safe rollout of CPT and REM in a resource-limited setting. Remdesivir recipients had less severe infection and better outcomes.
ClinicalTrials.gov identifier. NCT04570982.
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