aspergillus endophthalmitis: pars plana vitrectomy is an alternative

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SWARAJ BATRA. Department of Obstetrics and Gynaecology, Maulana. Azad Medical College and Lok Nayak Hospital, New. Delhi, India. Correspondence:.

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INDIAN JOURNAL OF MEDICAL SCIENCES

be, without compromising on their medical care. This was also followed in the present study. All women consented to being included in the study; perhaps as the study involved potential analgesic effects on labor,[2] the women were more than willing. In reply to your second query, it may be stated that a process of consecutive randomization was carried out if they fulÞlled the inclusion criteria. The study was blinded at two levels, neither the patients nor the assessors/ raters (who were residents in Obstetrics and Gynecology) knew about the content of the syringes or the group allocation. Also, the nurses administering the drug were not aware of its content. Hence it can be said that the internal validity was not compromised. Indeed, it was not a triple-blind study, as the data analyzer/ principal investigator was not blinded to the group allocation at the time of analyzing the results. As regards registration of trials, it is still not completely centralized in India, as is the case in other parts of the world; however, the process has started. PAKHEE AGGARWAL, VIJAY ZUTSHI, SWARAJ BATRA Department of Obstetrics and Gynaecology, Maulana Azad Medical College and Lok Nayak Hospital, New Delhi, India Correspondence: Dr. Pakhee Aggarwal C-I/11, Ansari Nagar, A.I.I.M.S. Campus (E), New Delhi - 110 029, India E-mail: [email protected]

REFERENCES

2009;63:364-5. 2. Aggarwal P, Zutshi V, Batra S. Role of hyoscine N-butyl bromide (HBB, buscopan ®) as labor analgesic. Indian J Med Sci 2008;62:179-84.

ASPERGILLUS ENDOPHTHALMITIS: PARS PLANA VITRECTOMY IS AN ALTERNATIVE Sir, I read with interest a case, reported by Hosseini et al.,[1] of a 22-year-old man with allogenic orthotopic liver transplantation who suffered from Aspergillus endophthalmitis. The visual outcome of this patient was poor, despite prompt intravenous treatment with amphotericin, switched to intravenous voriconazole. I agree that in the past, Aspergillus endophthalmitis was associated with very poor visual outcome,[2] but I have some concerns about the medical management and absence of surgical treatment, which could have led to such poor visual outcome. During the last few years, considerable effort has been made to recognize the main risks for an immunocompromised patient to suffer from fungal ocular infection. There have been some reports of successful outcome only with the addition of intravitreal amphotericin as an antifungal drug, [3-4] but better outcome has been achieved with surgery in cases of fungal endophthalmitis. It consists of pars plana vitrectomy,[5] as has been recently reported in the largest series of cases published, in which 73% (16/22) recovered visual acuity of ‘counting Þngers’ or better.

1. Jacob R. Hyoscine- B butyl bromide in labour: A randomised controlled trial. Indian J Med Sci Indian J Med Sci, Vol. 63, No. 8, August 2009

LUIS IGNACIO GONZALEZ-GRANADO

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LETTERS TO EDITOR

Department of Pediatrics, Hospital 12 Octubre. Correspondence: Av Andalucia km 5,400, 28041, Madrid, Spain E-mail: [email protected]

REFERENCES

McGregor CG, Patel R. Incidence and clinical characteristics of ocular infections after heart transplantation: A retrospective cohort study. Clin Transplant 2009;23:484-9. 4. Bakri SJ, Sears JE, Procop GW, Shrestha R, Gordon SM. Excellent visual outcome following

1. Hosseini H, Saki S, Saki N, Eghtedari M. Aspergillus endophthalmitis in orthotopic liver transplantation. Indian J Med Sci 2009;63:253-6. 2. Schiedler V, Scott IU, Flynn HW Jr, Davis JL, Benz MS, Miller D. Culture-proven endogenous endophthalmitis: Clinical features and visual

Aspergillus ßavus endogenous endophthalmitisfarmer’s lung disease. Int Ophthalmol 2009 [Available from http://www.springerlink.com/ content/yn403562171p7p87/]. 5. Shen X, Xu G. Vitrectomy for endogenous

acuity outcomes. Am J Ophthalmol 2004;137:

fungal endophthalmitis. Ocul Immunol Inßamm

725-31.

2009;17:148-52.

3. Del Pozo JL, van de Beek D, Daly RC, Pulido JS,

DOI: 10.4103/0019-5359.55892

Announcement Dr. J. C. Patel Medical Research Foundation is organizing Fifth Conference on Iron Deficiency at Shanti Sarovar, Hyderaban on 5 -7 February 2010. Early registration closes on 31/8/09. Only first 150 out-station delegates would be registered and would be provided free accommodation. Local delegates not requiring accommodation will have unrestricted registration. Last date for submission of abstracts for free papers is 15/11/09. All accepted abstracts would receive cash awards based on merits. For details conact: For outstation delegates – Dr. B. C. Mehta, 504, Pracho Society, Juhu-Versova Link Rd, Andheri (W) Mumbai 400 053. E-mail [email protected] Web-site www.ghrc.bk.org Indian J Med Sci, Vol. 63, No. 8, August 2009

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