Effects of COVID-19 pandemic on glaucoma appointment scheduling in a tertiary hospital in London, UK

PURPOSE: To investigate the impact of the delay in patient appointments caused by the COVID-19 pandemic and the triage system on the glaucomatous disease of patients in a London tertiary hospita METHODS: Observational retrospective study that randomly selected 200 glaucoma patients with more than 3 months of unintended delay for their post-COVID visit and other inclusion and exclusion criteria. Demographic information, clinical data, number of drugs, best-corrected visual acuity (BCVA), intraocular pressure (IOP), visual field (VF) mean deviation (MD), and global peripapillary retinal nerve fibre layer (pRNFL) thickness were obtained from the pre- and post-COVID visit. At the post-COVID visit, the clinical outcomes subjective clinical concern and change of treatment or need for surgery were also annotated. The variables were stratified by glaucoma severity (according to the MD into early, moderate and advanced) and by delay time (more and less than 12 months) and analysed using SPSS. RESULTS: We included 121 eyes (from 71 patients). The median patient age was 74 years (interquartile range -IQR- 15), 54% were males and 52% Caucasians. Different glaucoma types and all glaucoma severities were included. When data was stratified for glaucoma severity, at the pre-COVID visit, significant differences in BCVA, CCT and IOP were observed and there were significantly higher values in the early glaucoma group. The median follow-up delay was 11 months (IQR 8), did not differ between the glaucoma severity groups and did not correlate to the glaucoma severity. At the post-COVID visit, significant differences in BCVA, IOP, and Global pRNFL thickness were observed between the glaucoma severity groups, as lower BCVA and higher IOP and pRNFL thickness were observed in the early glaucoma group. At the post-COVID visit there was cause for concern in 40 eyes: 5 were followed more closely, 22 had a change of treatment and 13 were booked for surgery (3 for cataract and 10 for glaucoma surgery). However, the number of eyes with causes for concern were similar between the glaucoma severity groups and there was no correlation between these clinical outcomes and the delay of the post-COVID visit. The number of topical hypotensive medications increased significantly after the post-COVID visit, higher number of medications were observed in the advanced glaucoma group. When differences of IOP, MD and pRNFL thickness between the pre and post-COVID visit, only the MD difference was significantly different between the glaucoma severity groups because it was higher in the severe group. When data was stratified for delay longer or shorter than 12 months, no differences were observed between the groups except at the pre-COVID visit, when the numbers of patients with MD deviation >−6 dB had longer delay time. When differences in IOP, MD and RNFL thickness were calculated, only the pRNFL thickness showed significant differences between the delay groups, because it was higher in the longer delay group. Finally, when paired analysis of the variables at the pre- and post-COVID visits, stratified by glaucoma severity and delay were conducted, although there were no significant differences in IOP in any group, the BCVA decreased significantly in the overall group and in the longer delay groups, the number of hypotensive drugs increased significantly overall and in the moderate and advanced glaucoma, the MD of the VF worsened significantly in the overall group and in the early glaucoma and longer delay groups and the pRNFL thickness decreased significantly in all groups. CONCLUSIONS: We document that delayed care impacts negatively on the glaucomatous disease of our patients because at the post-COVID visit there were reasons for clinical concern in a third of eyes that resulted in change of treatment or surgery. However, these clinical consequences were not related to IOP, glaucoma severity or delay time and reflect that the triage methods implemented worked adequately. The most sensitive parameter to indicate progression in our sample was the pRNFL thickness

Antropologías hechas en Ecuador. Antología (Volumen I)

La serie Antropologías hechas en Ecuador forma parte de la Colección Antropologías hechas en América Latina, un proyecto editorial promovido por la Asociación Latinoamericana de Antropología con el objetivo de dibujar un mapa de las antropologías de América Latina que haga posible identificar sus genealogías, propuestas metodológicas, sus reflexiones y construcciones teórico-prácticas, con el objetivo de re-conocernos y buscar los puntos de soldadura y las preocupaciones que nos integran o diferencian. La publicación consta de dos partes. La primera es una Antología de dos volúmenes que recoge investigaciones basadas en el trabajo de campo y producidas por la academia durante las dos últimas décadas, principalmente, las cuales dan cuenta de una diversidad muy grande de autores y autoras, temáticas y enfoques. La segunda parte, Aportes actuales, también en dos volúmenes, está conformada por los artículos resultado de una convocatoria abierta e incluyen estados de la cuestión, lecturas críticas y reflexivas de trayectorias disciplinarias y, también, estudios de caso. En este primer volumen de la Antología constan los siguientes temas: Antropología amazónica, Antropología andina, Antropología de la costa, Antropología y Lingüística, Antropología y Educación, Cultura y Naturaleza y Antropología, Economía y Desarrollo

SARS-CoV-2 Delta-variant breakthrough infections in nursing home residents at midterm after Comirnaty® COVID-19 vaccination

Severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2) Delta variant break-through infections in nursing home residents following vaccination with Comirnaty®COVID‐19 vaccine were characterized. In total, 201 participants (median age, 87 years;range, 64–100; 133 female) from two nursing homes in the Valencian community (Spain)were included. SARS‐CoV‐2‐Spike (S) antibody responses were determined by a lateralflow immunocromatography (LFIC) assay and by quantitative electrochemiluminescentassay in LFIC‐negative participants. SARS‐CoV‐2‐S‐IFNγT cells were enumerated by flowcytometry in 10 participants. Nasopharyngeal SARS‐CoV‐2 RNA loads were quantified byreal‐time polymerase chain reaction assays. Vaccine breakthrough COVID‐19 due to theDelta variant occurred in 39 residents (median age, 87 years; range, 69–96; 31 female) ata median of 6.5 months after vaccination (nine requiring hospitalization). Breakthroughinfections occurred at a higher rate(p< 0.0001) in residents who had not been previouslyinfected with SARS‐CoV‐2 (naïve) (33/108; 18%) than in those with prior diagnosis ofSARS‐CoV‐2 infection (experienced) (6/93; 6.4%), and were more likely (p< 0.0001) todevelop in residents who tested negative by LFIC (20/49) at 3 months after vaccinationas compared to their LFIC‐positive counterparts (19/142). Among LFIC‐negativeresidents, a trend towards lower plasma anti‐RBD antibody levels was noticed in thosedeveloping breakthrough infection (p=0.16).SARS‐CoV‐2 RNA loads in nasopharyngealspecimens were lower in SARS‐CoV‐2‐experienced residents (p< 0.001) and in thosetesting positive by LFIC (p=0.13). The frequency of SARS‐CoV‐2‐S‐reactive T cells at3monthswassimilarinLFIC‐negative residents with (n=7) or without (n=3)breakthrough infection. Prior history of SARS‐CoV‐2 infection and detection ofS‐reactive antibodies by LFIC at 3 months is associated with a lower risk of Delta‐variant breakthrough infection in nursing home residents at midterm after Comirnaty®COVID‐19 vaccination.We are grateful to the Vice‐presidency and Ministry of Equality andInclusive Policies of the Valencia Community, the Corporate Associationof Residences and Services for People with Dependency of the ValencianCommunity (AERTE), the Valencia Health System nursing homedepartmental committees, and the staff and residents of the participantnursing homes for their collaboration in developing the ProVaVacprogram. We would also like to thank Ana Berenguer, General Directorof Analysis and Public Policies of the Presidency of the Generalitat.Ignacio Torres (Río Hortega Contract; CM20/00090) and Eliseo Albert(Juan Rodés Contract; JR20/00011) hold contracts funded by the HealthInstitute Carlos III (co‐financed by the European Regional DevelopmentFund, ERDF/FEDER). This study received no public or private funds.Peer reviewe

Reducing the environmental impact of surgery on a global scale: systematic review and co-prioritization with healthcare workers in 132 countries

Background Healthcare cannot achieve net-zero carbon without addressing operating theatres. The aim of this study was to prioritize feasible interventions to reduce the environmental impact of operating theatres. Methods This study adopted a four-phase Delphi consensus co-prioritization methodology. In phase 1, a systematic review of published interventions and global consultation of perioperative healthcare professionals were used to longlist interventions. In phase 2, iterative thematic analysis consolidated comparable interventions into a shortlist. In phase 3, the shortlist was co-prioritized based on patient and clinician views on acceptability, feasibility, and safety. In phase 4, ranked lists of interventions were presented by their relevance to high-income countries and low–middle-income countries. Results In phase 1, 43 interventions were identified, which had low uptake in practice according to 3042 professionals globally. In phase 2, a shortlist of 15 intervention domains was generated. In phase 3, interventions were deemed acceptable for more than 90 per cent of patients except for reducing general anaesthesia (84 per cent) and re-sterilization of ‘single-use’ consumables (86 per cent). In phase 4, the top three shortlisted interventions for high-income countries were: introducing recycling; reducing use of anaesthetic gases; and appropriate clinical waste processing. In phase 4, the top three shortlisted interventions for low–middle-income countries were: introducing reusable surgical devices; reducing use of consumables; and reducing the use of general anaesthesia. Conclusion This is a step toward environmentally sustainable operating environments with actionable interventions applicable to both high– and low–middle–income countries

Reducing the environmental impact of surgery on a global scale: systematic review and co-prioritization with healthcare workers in 132 countries

Abstract Background Healthcare cannot achieve net-zero carbon without addressing operating theatres. The aim of this study was to prioritize feasible interventions to reduce the environmental impact of operating theatres. Methods This study adopted a four-phase Delphi consensus co-prioritization methodology. In phase 1, a systematic review of published interventions and global consultation of perioperative healthcare professionals were used to longlist interventions. In phase 2, iterative thematic analysis consolidated comparable interventions into a shortlist. In phase 3, the shortlist was co-prioritized based on patient and clinician views on acceptability, feasibility, and safety. In phase 4, ranked lists of interventions were presented by their relevance to high-income countries and low–middle-income countries. Results In phase 1, 43 interventions were identified, which had low uptake in practice according to 3042 professionals globally. In phase 2, a shortlist of 15 intervention domains was generated. In phase 3, interventions were deemed acceptable for more than 90 per cent of patients except for reducing general anaesthesia (84 per cent) and re-sterilization of ‘single-use’ consumables (86 per cent). In phase 4, the top three shortlisted interventions for high-income countries were: introducing recycling; reducing use of anaesthetic gases; and appropriate clinical waste processing. In phase 4, the top three shortlisted interventions for low–middle-income countries were: introducing reusable surgical devices; reducing use of consumables; and reducing the use of general anaesthesia. Conclusion This is a step toward environmentally sustainable operating environments with actionable interventions applicable to both high– and low–middle–income countries

Capacidad diagnóstica de la densidad vascular papilar y macular frente a parámetros estructurales con tomografía de coherencia óptica en el glaucoma seudoexfoliativo

Purpose: To evaluate the diagnostic ability of the vessel density (VD) of the optic nerve head (ONH) and the macula on optical coherence tomography (OCT) angiography and the retinal nerve layer thickness (RNFL) thickness and the macular ganglion cell complex (GCC) thickness on OCT in patients with pseudoexfoliative glaucoma (PXG). Methods: Cross-sectional study including PXG patients and healthy controls. Demographic and clinical data were noted for all participants. Optical coherence tomography (OCT) and OCT angiography (OCTA) images of the ONH and macular area were obtained with the RS-3000 Advance OCT (Nidek Co., Gamagori, Japan). The RNFL and GCC thickness of different sectors was provided by the software. Macular VD of the superficial capillary plexus (SCP) and ONH VD of the radial peripapillary capillary plexus (RPCP) were registered. Groups were compared and area under the receiver operating characteristic (AUROC) curves were used to determine the power of discrimination of each parameter. Results: RNFL and GCC thickness and ONH and macular VD were significantly lower in PXG patients compared with healthy controls (all, p < 0.05). The best discrimination parameter was the average RNFL thickness (AUROC: 0.928). ONH VD AUROC was better than that of macular VD (AUROC: 0.897 and 0.780, respectively). ONH VD AUROC was comparable to RNFL thickness (p < 0.001). Conclusions: The diagnostic ability of ONH vessel density in PXG appears comparable to that of the structural parameters, RNFL and GCC thickness, obtained with OCT, and may be a valuable tool in clinical practice.Propósito: Evaluar la capacidad diagnóstica de la densidad de vasos (DV) papilar y macular mediante angiografía por tomografía de coherencia óptica (OCTA) y el grosor de la capa de fibras nerviosas de la retina (CFNR) y complejo de células ganglionares (CCG) maculares mediante tomografía de coherencia óptica (OCT) en los pacientes con glaucoma seudoexfoliativo (GPX). Métodos: Estudio transversal que incluyó GPX y controles sanos. Se realizó OCT y OCTA de la papila y el área macular con el OCT RS-3000 Advance (Nidek Co., Gamagori, Japón). Se registró la DV macular del plexo capilar superficial (SCP) y la DV papilar del plexo capilar peripapilar radial (RPCP). Se empleó el área bajo la curva característica operativa del receptor (AUROC) para determinar el poder discriminatorio de cada parámetro. Resultados: El grosor de la CFNR y del CCG, así como la DV a nivel papilar y macular, fueron significativamente menores en los pacientes con GPX que en los controles sanos (todos, p < 0,05). El mejor parámetro discriminante fue el grosor medio de la CFNR (AUROC: 0,928). El AUROC de la DV papilar fue mejor que el de la VD macular (AUROC: 0,897 y 0,780, respectivamente). AUROC de la DV papilar fue comparable a la del grosor de la CFNR (p < 0,001). Conclusiones: La capacidad diagnóstica de la DV papilar en el GPS parece comparable a la de los parámetros estructurales, espesor de la CFNR y CCG, obtenidos mediante OCT, por lo que la OCTA podría ser una herramienta valiosa en el GPX.Depto. de Inmunología, Oftalmología y ORLFac. de Óptica y OptometríaTRUEpu

Detection of anti-SARS-CoV-2 antibodies in tears: Ocular surface immunity to COVID-19 Detección de anticuerpos anti-SARS-CoV-2 en lágrimas: inmunidad de la superficie ocular frente a COVID-19

Purpose: To evaluate the presence of SARS-CoV-2 specific IgA and IgG antibodies in tears of unvaccinated and anti-COVID-19 vaccinated subjects with previous history of SARS-CoV-2 infection. To compare results in tears with those in saliva and serum and correlate with clinical data and vaccination regimens. Methods: Cross-sectional study including subjects with a previous history of SARS-CoV-2 infection, both unvaccinated and vaccinated against COVID-19. Three samples were collected: tears, saliva and serum. IgA and IgG antibodies against S-1 protein of SARS-CoV-2 were analyzed with a semi-quantitative ELISA. Results: Thirty subjects, mean age 36.4 ± 10, males 13/30 (43.3%) with history of mild SARS-CoV-2 infection were included. 13/30 (43.3%) subjects had received a 2-dose regimen and 13/30 (43.3%) a 3-dose regimen of anti-COVID-19 vaccine, 4/30 (13.3%) subjects were unvaccinated. All the participants with full anti-COVID-19 vaccination (2-or 3-doses) presented detectable anti-S1 specific IgA in all 3 biofluids, tears, saliva and serum. Among unvaccinated subjects, specific IgA was detected in 3/4 subjects in tears and saliva, whereas IgG was not detected. Considering IgA and IgG antibodies titers, no differences were observed between the 2- and 3-dose vaccination regimen. Conclusions: SARS-CoV-2-specific IgA and IgG antibodies were detected in tears after mild COVID-19, highlighting the role of the ocular surface as a first line of defense against infection. Most naturally infected unvaccinated individuals exhibit long-term specific IgA in tears and saliva. Hybrid immunization (natural infection plus vaccination) appears to enhance mucosal and systemic IgG responses. However, no differences were observed between the 2- and 3-dose vaccination schedule.This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors