Incidence of ocular complications in patients with multibacillary leprosy after completion of a 2 year course of multidrug therapy

Aim: To evaluate the incidence of and risk factors for ocular complications in multibacillary (MB) leprosy patients following completion of 2 year, fixed duration, multidrug therapy (MDT). Methods: Biannual eye examinations were conducted prospectively on a cohort of MB patients who had completed MDT and followed up for 5 years. The incidence of ocular pathology was calculated as the number of events per person year of event free follow up of patients who did not have the specific finding before completion of MDT. Results: 278 patients had one or more follow up visits after completion of MDT. The incidence of lagophthalmos was 0.24%/patient year (95% CI 0.10% to 0.37%); corneal opacity, 5.35%/patient year (95% CI 4.27% to 6.70%); uveal involvement, 3.78%/patient year (95% CI 2.96% to 4.83%); and cataract that reduced vision to 6/18 or less, 2.4%/patient year (95% CI 1.77% to 3.26%). Overall, 5.65%/patient year (95% CI 4.51% to 7.09%) developed leprosy related ocular disease and 3.86%/patient year (95% CI 3.00% to 4.95%) developed leprosy related, potentially blinding ocular pathology during the period following MDT. Age and other disability also predicted incident eye disease. Conclusions: Every year, approximately 5.6% of patients with MB who have completed MDT can be expected to develop new ocular complications of leprosy, which often (3.9%) are potentially vision threatening. Because many of these complications cannot be detected without slit lamp examination, periodic monitoring, particularly of older patients and those with other disability, is recommended, in order to detect and treat ocular complications satisfactorily. I t is estimated that by the end of the year 2005, more than 14 million leprosy patients will have completed a standard course of anti-leprosy multidrug therapy (MDT). 1 Although the incidence of leprosy is declining in some areas, approximately half a million new patients are diagnosed with leprosy each year. Recent changes in the epidemiology of leprosy include a gradual shift in the proportion of the type of leprosy from the paucibacillary to the multibacillary (MB) form, as well as a shift to an older age at diagnosis of disease. 2 Improving health care and socioeconomic conditions predict increasing survival, with the fortunate result that there will be an ever increasing number of antimicrobially ''cured'' leprosy patients than ever existed in history. There is evidence that even after adequate treatment with MDT, a sizeable proportion of cured leprosy patients continue to manifest progressive impairment of nerve function. Although the pathophysiology of this process is not fully understood, it is thought to be related to continuing immunological reactions and slow evolution of pre-existing nerve damage. Ocular complications are frequently observed in newly diagnosed leprosy patients and in patients who are undergoing MDT. 7-9 However, little information exists on the incidence of ocular complications after completion of MDT in MB patients who have completed the recommended course of MDT. Knowledge of the risk and nature of ocular morbidity in leprosy patients after treatment with MDT is needed to prevent and/or manage such complications promptly and effectively in programmes worldwide. Such information potentially could identify risk factors that may be amenable to intervention and help prioritise groups for more active follow up. In our previous reports, we have described a cohort of newly diagnosed MB leprosy patients who were followed for ocular complications during 2 year fixed MDT. 8 10 These patients were followed up for a further 5 years. In this paper, we report information on ocular complications that were incident during the post-MDT period. MATERIAL AND METHODS All new clinically diagnosed MB patients starting on a 2 year MDT and living within the leprosy control area of the Schieffelin Leprosy Research and Training Centre in southern India were invited to participate. Recruitment began in 1991 and was completed in 1997. Consenting patients received a baseline ocular examination followed by biannual examinations during MDT and for a period of at least 5 years after completion of MDT. Based on sample size calculations taking into account possible losses to follow up resulting from migration and mortality, 301 MB leprosy patients were enrolled over a period of 6 years. Research methods and protocols were approved by the institutional review board of the Schieffelin Leprosy Research and Training Centre. All patients were examined and given treatment free of charge. At enrolment the following leprosy characteristics were recorded; the type of MB leprosy, based on the clinical classification of Ridley and Jopling 11 ; deformity grading of hands and legs, based on the WHO classification 12 ; the bacterial index, calculated from the results of the acid fast staining of smears from specific skin sites 13 ; presence or Abbreviations: LROP, leprosy related ocular pathology; MB, multibacillary; MDT, multidrug therapy; PBLROP, potentially blinding leprosy related ocular pathology 949 www.bjophthalmol.co

Mortality and pulmonary complications in patients undergoing surgery with perioperative SARS-CoV-2 infection: an international cohort study

Background: The impact of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) on postoperative recovery needs to be understood to inform clinical decision making during and after the COVID-19 pandemic. This study reports 30-day mortality and pulmonary complication rates in patients with perioperative SARS-CoV-2 infection. Methods: This international, multicentre, cohort study at 235 hospitals in 24 countries included all patients undergoing surgery who had SARS-CoV-2 infection confirmed within 7 days before or 30 days after surgery. The primary outcome measure was 30-day postoperative mortality and was assessed in all enrolled patients. The main secondary outcome measure was pulmonary complications, defined as pneumonia, acute respiratory distress syndrome, or unexpected postoperative ventilation. Findings: This analysis includes 1128 patients who had surgery between Jan 1 and March 31, 2020, of whom 835 (74·0%) had emergency surgery and 280 (24·8%) had elective surgery. SARS-CoV-2 infection was confirmed preoperatively in 294 (26·1%) patients. 30-day mortality was 23·8% (268 of 1128). Pulmonary complications occurred in 577 (51·2%) of 1128 patients; 30-day mortality in these patients was 38·0% (219 of 577), accounting for 81·7% (219 of 268) of all deaths. In adjusted analyses, 30-day mortality was associated with male sex (odds ratio 1·75 [95% CI 1·28–2·40], p\textless0·0001), age 70 years or older versus younger than 70 years (2·30 [1·65–3·22], p\textless0·0001), American Society of Anesthesiologists grades 3–5 versus grades 1–2 (2·35 [1·57–3·53], p\textless0·0001), malignant versus benign or obstetric diagnosis (1·55 [1·01–2·39], p=0·046), emergency versus elective surgery (1·67 [1·06–2·63], p=0·026), and major versus minor surgery (1·52 [1·01–2·31], p=0·047). Interpretation: Postoperative pulmonary complications occur in half of patients with perioperative SARS-CoV-2 infection and are associated with high mortality. Thresholds for surgery during the COVID-19 pandemic should be higher than during normal practice, particularly in men aged 70 years and older. Consideration should be given for postponing non-urgent procedures and promoting non-operative treatment to delay or avoid the need for surgery. Funding: National Institute for Health Research (NIHR), Association of Coloproctology of Great Britain and Ireland, Bowel and Cancer Research, Bowel Disease Research Foundation, Association of Upper Gastrointestinal Surgeons, British Association of Surgical Oncology, British Gynaecological Cancer Society, European Society of Coloproctology, NIHR Academy, Sarcoma UK, Vascular Society for Great Britain and Ireland, and Yorkshire Cancer Research

The value of open-source clinical science in pandemic response: lessons from ISARIC

International audienc

ISARIC-COVID-19 dataset: A Prospective, Standardized, Global Dataset of Patients Hospitalized with COVID-19

The International Severe Acute Respiratory and Emerging Infection Consortium (ISARIC) COVID-19 dataset is one of the largest international databases of prospectively collected clinical data on people hospitalized with COVID-19. This dataset was compiled during the COVID-19 pandemic by a network of hospitals that collect data using the ISARIC-World Health Organization Clinical Characterization Protocol and data tools. The database includes data from more than 705,000 patients, collected in more than 60 countries and 1,500 centres worldwide. Patient data are available from acute hospital admissions with COVID-19 and outpatient follow-ups. The data include signs and symptoms, pre-existing comorbidities, vital signs, chronic and acute treatments, complications, dates of hospitalization and discharge, mortality, viral strains, vaccination status, and other data. Here, we present the dataset characteristics, explain its architecture and how to gain access, and provide tools to facilitate its use

Characteristics and outcomes of COVID-19 patients admitted to hospital with and without respiratory symptoms

Background: COVID-19 is primarily known as a respiratory illness; however, many patients present to hospital without respiratory symptoms. The association between non-respiratory presentations of COVID-19 and outcomes remains unclear. We investigated risk factors and clinical outcomes in patients with no respiratory symptoms (NRS) and respiratory symptoms (RS) at hospital admission. Methods: This study describes clinical features, physiological parameters, and outcomes of hospitalised COVID-19 patients, stratified by the presence or absence of respiratory symptoms at hospital admission. RS patients had one or more of: cough, shortness of breath, sore throat, runny nose or wheezing; while NRS patients did not. Results: Of 178,640 patients in the study, 86.4 % presented with RS, while 13.6 % had NRS. NRS patients were older (median age: NRS: 74 vs RS: 65) and less likely to be admitted to the ICU (NRS: 36.7 % vs RS: 37.5 %). NRS patients had a higher crude in-hospital case-fatality ratio (NRS 41.1 % vs. RS 32.0 %), but a lower risk of death after adjusting for confounders (HR 0.88 [0.83-0.93]). Conclusion: Approximately one in seven COVID-19 patients presented at hospital admission without respiratory symptoms. These patients were older, had lower ICU admission rates, and had a lower risk of in-hospital mortality after adjusting for confounders