Challenging case of treating fungal keratitis.

Objective: Treating fungal keratitis is always a challenge due to limited antifungal medication, their poor penetration, and often, the delay in diagnosis. The purpose of this study is to present new routes of medication delivery, such as intrastromal application for advanced cases not responding to topical therapy. Methods: A 60-year-old female presented with fungal keratitis, complaining of decreased vision, redness in her left eye followed by frequent pain, which got worse a few days prior. Visual acuity was limited to hand motion. Slit-lamp examination showed advanced conjunctival hyperemia, a very deep white feathery lesion in the central cornea, with satellite lesions on the periphery, and pseudohypopyon of 3 mm in the anterior chamber. She was started on oral fluconazole 100 mg b.i.d, followed by corneal debridement and topical hourly voriconazole eye drops and intrastromal voriconazole application as her local findings did not show any improvement. Results: After repeating the procedure three times, the inflammatory reaction was decreased, the central ulcer healed, satellite lesions disappeared and pseudohypopyon did not recur even after discontinuation of the topical therapy. Conclusion: Intrastromal voriconazole application showed its safety and efficacy in treating advanced fungal keratitis with deep intrastromal lesions. Abbreviations: NSAID = non-steroid anti-inflammatory drugs, BCVA = best corrected visual acuity, MIC = mean inhibitory concentration.

Possibilities of infection and increase of intraocular pressure after intravitreal application of bevacizumab in treatment of exudative form of AMD.

THE GOAL: To establish the frequency increase of intraocular pressure (IOP) and endophthalmitis as well as other complications that may occur after intravitreal application of bevacizumab. SUBJECTS AND METHODOLOGY: The study included 45 patients and 75 eyes with exudative form of senile degeneration of macula lutea, who were treated in the General Hospital "Prim. Dr. Abdulah Nakas" from 2007. and 2010., the patients being aged between 55 and 75 years. The intraocular pressure (IOP) was measured before the application of bevacizumab, and then after 1st, 2nd and 3rd dose, and it was examined by the bio-microscope two days after the application of bevacuzimab. RESULT: The average age of the patients treated by bevacizumab was 71.27 years (71 years, 3 months, and 7 days); 28 patients were females and 17 were males. The examination by bio-microscope indicates changes at certain number of patients. After first dose of bevacizumab, there were 9 suffusions of the bulbar conjuctiva in the application area. After the second dose, there were 10 of them, while after the third dose of bevacizumab, there were 5 suffusions and 3 cases of inflammation of the anterior eye segment, anterior uveitis. As for the intraocular pressure, there is no statistically significant difference (p > 0.05) for any measuring period. CONCLUSION: Based on the results achieved in the intravitreal application of bevacizumab in treatment of senile degeneration of macula lutea, we can conclude that there is a possibility of infection after intravitreal application of bevacizumab, but it is minimal when working in a sterile environment. Increased intraocular pressure is possible, but not necessarily to happened after the intravitreal application of the drug.

Optimization of diagnostic ELISA-based tests for the detection of auto-antibodies against tumor antigens in human serum.

Colorectal cancer is one of the most common cancer types worldwide and it continues to be a serious public health problem. Early detection and diagnosis are of great importance in cancer management. At present, diagnostic blood tests are based on the detection of tumor-associated markers such as carcino-embryonic antigen (CEA), the cancer antigen CA19-9 for gastrointestinal cancer, CA15-3 for breast cancer or CA125 for ovarian cancer. The lack of sensitivity and specificity of these markers prevents their general use in cancer screening of an average risk population. Therefore, new cancer biomarkers or better screening methods are necessary to improve the diagnostics of the disease. This study was directed to the optimization of a diagnostic, enzyme linked immunosorbent assay (ELISA) based test to identify and validate new serum markers, such as extracellular Protein Kinase A (ecPKA) and Nicotinamide N-Methyltransferase (NNMT). In this type of assay, the cancer antigens are quantified indirectly - by detecting the presence of auto-antibodies against tumor proteins in human serum. The result of the optimization and validation process was in the case of ecPKA a reproducible and stable assay. In case of NNMT the assay was probably not sensitive enough.