Ocular surgery and its role of Microorganisms

Lata Ghimire, Micro-Biologist, NCWA

Eyes, the vital sense organ is responsible for sight. The important structures of eyes are scelera, cornea, retina, iris, pupil and lens. Other accessory organs important for proper functioning of the eyes are eye brows, eye lids, eyelashes, conjunctiva, the lacrymal apparatus and the muscles of the eyes.

Nepal is the country with the high geographic variation. Education has not been possible yet to the remote areas. Still majority of the people of the village and distant hills are not conscious about different health problems, especially various types of eye problems resulting the blindness in most cases.

Besides these infections, cataract is very much common in the older age. The transparent human crystalline which is situated inside the eye just behind the pupil is responsible for focusing the incoming light rays to retina. As age advances the lens looses its transparency and becomes opaque, this condition is called cataract and results in the blindness. It is the commonest cause of blindness in the world. There are approximately 16 million people who are blind from cataract.

Cataract sometimes may be resulted from the diseases as diabetes or injury to the eye. They may occur in the children sometimes as a congenital defect. Ocular surgery is one of the most commonly performed operation world over. Again cataract extraction is the commonest of all eye operation.. One of the devastating complication of intra ocular surgery is the ensuing infection. Most of these infection are caused by microorganisms which are present in and around the eyes. Opening of the eye during surgery result in these organisms gain access into the intra ocular tissues and causes distraction which often is irreversible causing permanent blindness.

Post operative infection is a known cause of estrogenic blindness. Cataract being the commonest cause of curable blindness, is the most frequently performed surgical procedure. The rate of infection varies from 0.04% to 5%. Most of the micro organisms responsible for this infection resides in and around the eye. So the patient is undoubtedly the source of the infection in most cases. The application of the antimicrobial agents removes the microorganisms in pre operative state. Povidone Iodine 5% applied for 10minutes is widely used disinfectant which kills microorganisms present on the outer surface of eyes as conjunctiva and helps in the prevention of the infection a great deal.

In the recent past the most frequent bacterial pathogen isolated in all cases of post operative endophthalmitis was Staphylococcus aureus in about 50% of cases Pseudomonas sps and Proteus sps made up approximately 25% of infection with other miscellaneous opportunistic organisms, especially Streptococcus sps,responsible for the rest.In the past Staphylococcus epidermis was thought to be non pathogenic organisms however the pre operative cultures of the conjunctiva have shown that the eyes are rarely sterile and the Staph. epidermis is found in over 50% of pre operative cultures.

The virulence of various bacterial species for the human eye is rather variable. At one end of the spectrum are highly virulent organisms as the Meningococcus, which produces an acute inflammatory process capable of involving many parts of the eye with occasional dissemination from the eye to the meanings. On the other end of the spectrum, is Staph. epidermis which is rarely a pathogen.

Staphylococcus aureus and Staph. epidermis together account for a large percentage of central corneal ulceration at the present time. Even though Staph.aureus is usually considered to be pathogenic for humans and Staph.epidermidis is felt to be part of normal flora of the body, both organisms elaborate enzymes and toxins which under the proper condition can produce corneal ulceration.

The Styphylococcal infections occur more frequently because the conditon permit the organisms to gain accessto the tisues are numerous and frequent in occurrence.It has become important cause of sepsis in man.In addition to causing minor superficial sepsis, they are now responsible for many systematic infection including conjunctivitis, endocarditis septicimea meningitis, peritonitis etc Staphylococcus epidermidis has also been supposed as important opportunistic pathogen.

Streptococcus sps again has in recent years become one of the most frequent cause of corneal ulceration. Fortunately the organism is of low grade pathogenicity and in most cases produce a characteristically indolent inflammatory reaction.

The coliform organisms if present in the eye indicate the poor hygienic condition of the patient. If coliform organisms are present during intraocular surgery, disasterous result can ensue. Members of this family are present frequently in human body as commensals and opportunistic pathogens and in the environment as well..Pseudomonas, a member of this family is one of the most destructive pathogen affecting the cornea. Suspected infections with the organisms is an ophthalmic emergency and appropriate laboratories studies and treatment should be instituted without delay.

The Situation of Journalists in Nepal-II

Binod Dhungel

BEGINNING OF CRISIS

Prevailing crisis to the Nepali press no doubt originated with the beginning of the armed conflict in the country. But it surfaced prominently only after the State of Emergency was imposed nationwide in November 2001 with a view to curbing the rebel forces and their insurgency drives.

During the State of Emergency, Nepali press was faced with many legal restrictions. Not only the Constitutional freedom, even some clauses of the Press and Publication Act had been suspended. Government had issued a directive regarding what the press ‘should’ do and what it ‘should not’. This resulted in the decreasing of the press freedom. Actions against the press did not follow any legal norms or procedure. Random arrests, seizure of publication and desktop material, detaining of journalists with a 90-day warrant under the Terrorism and Disruptive Activities Ordinance (TADO), which was later passed into an Act (But now it is ordinance again. The Act was declared only for two years. Then after, we don’t have parliament), inflicting torture, and custodial killings were some of the practices committed by the State machineries.

Maoists then were not as reluctant to the press as they are today. Although they also blocked reporters from going to remote places to collect news, and kidnapped pressmen and even killed some reporters on charge of spying against them.

Emergency was a special situation. The exercises of freedom naturally get curbed during such times. This is why the Nepali press acted in a rather positive and responsible manner. However, the press opposed to the undue extension of Emergency. So much so that the press was agitated during this very time.

During the peace talks, the press was very much cooperative towards making the talks successful. The attitude of the government and the Maoist rebels also seemed to be more positive than before. Apparently, the government was regretful of its suppression of the press during the State of Emergency. And the Maoists were also positive in recognizing the role of the media, as they admitted that they found the independent press in Nepal stronger than what they had actually thought it to be. However, it was clear that both the sides underscored the importance of the press. Both of them tried to capitalize on the potential of the press.

After the talks broke out, not only Maoists but also all their channels of information went into hiding. As the State security rnachineries started looking at the mainstream press and the journalists with crooked eyes, and with a sense of distrust, they also arrested journalists, seized print/broadcast materials and sporadically forced them to disclose the sources of news.

Basic Trends in violation of Press Freedom

According to Article 13 of the Constitution of the Kingdom of Nepal, censorship against the press cannot be practiced even during the State of Emergency. And Article 116 of the Constitution not only prohibits the making of any law but also prohibits the amendment in Constitution in a way that may curb the press freedom. However, practically, the press is not totally free from censorship even today.

Growing Militarization: As a result of growing militarization, more and more explicit signs are emerging to testify that the freedom of press will suffer further crisis in Nepal. The press has been a direct victim of the "Unified Command" of the government. Under this, all security machineries of the government are mobilized under the leadership of the Royal Nepalese Army.

This is why reports on security actions do not come in authentic manner. Reporters are hardly in a position to file news on such actions, as that would involve ‘risk’. First, the security actions mostly take place secretly; so the press hardly knows about it. Second, it is a high-risk work for a reporter to reach tile spots of security actions. Third, even if a reporter succeeds to get his or her stories (relating to such security actions) printed or publicized, it is at the risk of endangering one’s own security. This is why the information relating to the Army-led security operations is not coming up so easily; nor can we regard the information that comes out as factual

Government apathy: The government, especially after the October: 4, 2002 Royal takeover of the executive power, is highly bent on using tile media in favor of Security forces and tile monarch. One evening, His Majesty King Gyanendra attended a dinner reception with senior journalists at the residence of the Chief of Army Staff, Pyarjung Thapa. The dinner was arranged to scoff at the media in general for their critical attitude towards the monarch’s October 4 move. Obviously, the Army is always critical of the popularity and the professional impact of the commercial media.

In his much-touted interview with the TIME magazine, the King had said that he had received complaints that Nepalese media had been a bit cruel against the security forces.

No sooner did the then Information and Communications Minister Kamal Thapa assumes the portfolio of Home Ministry, blamed the media for "boosting the morale of the Maoists". Not only that, he also warned the media of "stern action" as such acts boosting the morale of the Maoists were against law. The then government arrested 75 journalists on April 16, 2004, when they were collecting news of street protest of agitating five parliamentary parties. In this incident, FNJ condemned the governments’ step and carried a move against that. The movement succeed to apologize the then Prime ­minister Surya Bahadur Thapa and demanded the resignation of Minister Kamal Thapa. In that movement more than five hundred journalists were arrested. Finally, the government collapsed and situation changed.

Editorial freedom: Collection of information, protection of information dissemination or distribution of news (flow of newspapers), and even the flow of advertisement suffer undeclared restrictions at the moment. Editorial freedom is directly or indirectly curtailed, advertisement market has gone down, and the safety of a. journalist threatened. There is no guarantee that a reporter’s work as a journalist would remain free from any violent reactions from government or other sectors. Journalists have not been able to work under an atmosphere guaranteed by the Constitution. No journalist can exercise his pen before carefully thinking about the possible consequences of his/her story on his own family members. Such is the danger from security forces and the rebels both.

( The author is central committee member of the FNJ)

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