Computer vision syndrome among university students during the corona virus pandemic

Computer vision syndrome (CVS) is a group of eye and visual problems related to computer use and it is associated with near work. The aim is to determine CVS prevalence, major complaints and main preventive practices among the University of Jordan students after the COVID-19 pandemic era. We conducted a cross-sectional descriptive study using an online pre-tested structured questionnaire. Each participant completed the questionnaire before and after the COVID-19 pandemic and the results were compared. A total of 634 students were included in the study. A high prevalence of CVS was observed after the COVID 19 era. The most significant risk factors for the presence of CVS before and after the pandemic were daily hours use of E-device for studying (p<0.001) and the use of glasses or contact lens (p<0.05). Brightness adjustment, keeping sufficient distance away from the device, taking breaks, increasing the screen font size and using eye drops were the most significant preventive measures taken by students before and after the pandemic (p<0.05). It is a necessity to raise awareness among students regarding computer related health problems and preventive measures need to be adopted to address the risk factors

Surgical site infection after gastrointestinal surgery in high-income, middle-income, and low-income countries: a prospective, international, multicentre cohort study

Background: Surgical site infection (SSI) is one of the most common infections associated with health care, but its importance as a global health priority is not fully understood. We quantified the burden of SSI after gastrointestinal surgery in countries in all parts of the world. Methods: This international, prospective, multicentre cohort study included consecutive patients undergoing elective or emergency gastrointestinal resection within 2-week time periods at any health-care facility in any country. Countries with participating centres were stratified into high-income, middle-income, and low-income groups according to the UN's Human Development Index (HDI). Data variables from the GlobalSurg 1 study and other studies that have been found to affect the likelihood of SSI were entered into risk adjustment models. The primary outcome measure was the 30-day SSI incidence (defined by US Centers for Disease Control and Prevention criteria for superficial and deep incisional SSI). Relationships with explanatory variables were examined using Bayesian multilevel logistic regression models. This trial is registered with ClinicalTrials.gov, number NCT02662231. Findings: Between Jan 4, 2016, and July 31, 2016, 13 265 records were submitted for analysis. 12 539 patients from 343 hospitals in 66 countries were included. 7339 (58·5%) patient were from high-HDI countries (193 hospitals in 30 countries), 3918 (31·2%) patients were from middle-HDI countries (82 hospitals in 18 countries), and 1282 (10·2%) patients were from low-HDI countries (68 hospitals in 18 countries). In total, 1538 (12·3%) patients had SSI within 30 days of surgery. The incidence of SSI varied between countries with high (691 [9·4%] of 7339 patients), middle (549 [14·0%] of 3918 patients), and low (298 [23·2%] of 1282) HDI (p < 0·001). The highest SSI incidence in each HDI group was after dirty surgery (102 [17·8%] of 574 patients in high-HDI countries; 74 [31·4%] of 236 patients in middle-HDI countries; 72 [39·8%] of 181 patients in low-HDI countries). Following risk factor adjustment, patients in low-HDI countries were at greatest risk of SSI (adjusted odds ratio 1·60, 95% credible interval 1·05–2·37; p=0·030). 132 (21·6%) of 610 patients with an SSI and a microbiology culture result had an infection that was resistant to the prophylactic antibiotic used. Resistant infections were detected in 49 (16·6%) of 295 patients in high-HDI countries, in 37 (19·8%) of 187 patients in middle-HDI countries, and in 46 (35·9%) of 128 patients in low-HDI countries (p < 0·001). Interpretation: Countries with a low HDI carry a disproportionately greater burden of SSI than countries with a middle or high HDI and might have higher rates of antibiotic resistance. In view of WHO recommendations on SSI prevention that highlight the absence of high-quality interventional research, urgent, pragmatic, randomised trials based in LMICs are needed to assess measures aiming to reduce this preventable complication

Evaluation of Changes in the Ganglionic Cell Inner Plexiform Layer and Macular Retinal Nerve Fibre Layer in Patients Receiving Hydroxychloroquine

Abstract Backgrounds: To evaluate changes in the thickness of ganglionic cell-inner plexiform layer and macular retinal nerve fiber layer using ocular coherence tomographyin patients exposed to hydroxychloroquine .Methods: This was a retrospective, cross-sectional study of patients on hydroxychloroquine therapy. Ocular coherence tomography images showing of ganglionic cell-inner plexiform cell layer and macular retinal nerve fiber layer thickness were obtained and compared to those of the control groups. The relationship between the thickness of of ganglionic cell-inner plexiform and macular retinal nerve fibre layer and the duration and cumulative dose of hydroxychloroquine was evaluated.Results: In all, 219 patients were included in this study; the mean age was 43.38 (±17.39) years. The study group comprised 100 (20 male and 80 female) patients, with a mean age of 45.28 (± 12.24) years; the control group had 119 patients (44 males and 75 females), with a mean age of 41.79 (± 20.67) years, with no significant difference in age between the groups (p = 0.123). There was a significant difference in mean of ganglionic cell-inner plexiform thickness between the study and control groups (85.6+/- 8 μm ) vs. (88.6+/-6 μm ) (p = 0.006), with a mean difference of 0.31 (95% confidence interval). The average RNFL thickness was similar in the study and control groups, 28.8±2.5 μm (range: 23 – 38) and 29.2±2.8 μm (range: 22 – 35) respectively, (p = 0.389). There was no significant correlation between of ganglionic cell-inner plexiform and macular retinal nerve fibre layer with daily dose (p = 0.229) or cumulative dose of hydroxychloroquine (p = 0.678). Conclusion : The average thickness of ganglionic cell -inner plexiform cell layer was significantly lower in those taking hydroxychloroquine than in controls. Thinning of this layer could be an early indicator of retinal toxicity before the appearance of clinical retinopathy. However, thickness of the macular retinal nerve fibre laye showed no decrease in hydroxychloroquine users and did not correlate with the duration or cumulative doses of hydroxychloroquine. Therefore, macular retinal nerve fibre layer thickness is not a useful biomarker for the early detection of hydroxychloroquine retinal toxicity.</jats:p

Delayed Intravitreal Anti-VEGF Therapy for Patients During the COVID-19 Lockdown: An Ethical Endeavor

Purpose To assess the impact of Jordanian's Corona Virus Disease (COVID-19) lockdown on visual acuity and macular thickness in patients with macular edema receiving intravitreal injections, and to assess the ethical endeavor of lockdown among serious sight threatening conditions. Patients and Methods This retrospective observational study included patients planned for intravitreal injections who did not complete the planned course before the lockdown (ie, before 20th of March 2020). Data included demographics, indication for the intravitreal injection, corrected distance visual acuity (CDVA), and central macular thickness on Optical Coherence Tomography (OCT) before and after the lockdown. Results One-hundred and sixty-six eyes of 125 patients were studied, 68 (54.4%) patients were males, and the mean (± standard deviation, SD) age was 64.79 (±9.41) years. Mean (±SD) duration of delay in the planned injection was 60.97 (±24.35) days. The change in visual acuity was statistically significant for patients with diabetic macular edema (p= 0.045 improvement), patients with central retinal vein thrombosis (CRVO) (p= 0.05 deterioration), and patients with age-related macular degeneration (AMD) (p= 0.005 deterioration). Of interest, delay of more than 2 months and the previous need for 3 or more injections were significant poor prognostic factors for visual outcome for patients with diabetic macular edema (p=0.027 and 0.045). Conclusion The impact of delay in the scheduled intravitreal injections resulted in variable outcomes depending on the indication. Triaging the urgency of patients should be based on the indication to support the equity principle of bioethics, where those in need are prioritized against others, depending on potential adverse outcome

Surgical site infection after gastrointestinal surgery in children : an international, multicentre, prospective cohort study

Introduction Surgical site infection (SSI) is one of the most common healthcare-associated infections (HAIs). However, there is a lack of data available about SSI in children worldwide, especially from low-income and middle-income countries. This study aimed to estimate the incidence of SSI in children and associations between SSI and morbidity across human development settings. Methods A multicentre, international, prospective, validated cohort study of children aged under 16 years undergoing clean-contaminated, contaminated or dirty gastrointestinal surgery. Any hospital in the world providing paediatric surgery was eligible to contribute data between January and July 2016. The primary outcome was the incidence of SSI by 30 days. Relationships between explanatory variables and SSI were examined using multilevel logistic regression. Countries were stratified into high development, middle development and low development groups using the United Nations Human Development Index (HDI). Results Of 1159 children across 181 hospitals in 51 countries, 523 (45 center dot 1%) children were from high HDI, 397 (34 center dot 2%) from middle HDI and 239 (20 center dot 6%) from low HDI countries. The 30-day SSI rate was 6.3% (33/523) in high HDI, 12 center dot 8% (51/397) in middle HDI and 24 center dot 7% (59/239) in low HDI countries. SSI was associated with higher incidence of 30-day mortality, intervention, organ-space infection and other HAIs, with the highest rates seen in low HDI countries. Median length of stay in patients who had an SSI was longer (7.0 days), compared with 3.0 days in patients who did not have an SSI. Use of laparoscopy was associated with significantly lower SSI rates, even after accounting for HDI. Conclusion The odds of SSI in children is nearly four times greater in low HDI compared with high HDI countries. Policies to reduce SSI should be prioritised as part of the wider global agenda.Peer reviewe

Surgical site infection after gastrointestinal surgery in high-income, middle-income, and low-income countries: a prospective, international, multicentre cohort study

Surgical site infection (SSI) is one of the most common infections associated with health care, but its importance as a global health priority is not fully understood. We quantified the burden of SSI after gastrointestinal surgery in countries in all parts of the world