Travel burden and clinical presentation of retinoblastoma: analysis of 1024 patients from 43 African countries and 518 patients from 40 European countries

BACKGROUND: The travel distance from home to a treatment centre, which may impact the stage at diagnosis, has not been investigated for retinoblastoma, the most common childhood eye cancer. We aimed to investigate the travel burden and its impact on clinical presentation in a large sample of patients with retinoblastoma from Africa and Europe. METHODS: A cross-sectional analysis including 518 treatment-naïve patients with retinoblastoma residing in 40 European countries and 1024 treatment-naïve patients with retinoblastoma residing in 43 African countries. RESULTS: Capture rate was 42.2% of expected patients from Africa and 108.8% from Europe. African patients were older (95% CI -12.4 to -5.4, p<0.001), had fewer cases of familial retinoblastoma (95% CI 2.0 to 5.3, p<0.001) and presented with more advanced disease (95% CI 6.0 to 9.8, p<0.001); 43.4% and 15.4% of Africans had extraocular retinoblastoma and distant metastasis at the time of diagnosis, respectively, compared to 2.9% and 1.0% of the Europeans. To reach a retinoblastoma centre, European patients travelled 421.8 km compared to Africans who travelled 185.7 km (p<0.001). On regression analysis, lower-national income level, African residence and older age (p<0.001), but not travel distance (p=0.19), were risk factors for advanced disease. CONCLUSIONS: Fewer than half the expected number of patients with retinoblastoma presented to African referral centres in 2017, suggesting poor awareness or other barriers to access. Despite the relatively shorter distance travelled by African patients, they presented with later-stage disease. Health education about retinoblastoma is needed for carers and health workers in Africa in order to increase capture rate and promote early referral

Is the meiofauna a good indicator for climate change and anthropogenic impacts?

Our planet is changing, and one of the most pressing challenges facing the scientific community revolves around understanding how ecological communities respond to global changes. From coastal to deep-sea ecosystems, ecologists are exploring new areas of research to find model organisms that help predict the future of life on our planet. Among the different categories of organisms, meiofauna offer several advantages for the study of marine benthic ecosystems. This paper reviews the advances in the study of meiofauna with regard to climate change and anthropogenic impacts. Four taxonomic groups are valuable for predicting global changes: foraminifers (especially calcareous forms), nematodes, copepods and ostracods. Environmental variables are fundamental in the interpretation of meiofaunal patterns and multistressor experiments are more informative than single stressor ones, revealing complex ecological and biological interactions. Global change has a general negative effect on meiofauna, with important consequences on benthic food webs. However, some meiofaunal species can be favoured by the extreme conditions induced by global change, as they can exhibit remarkable physiological adaptations. This review highlights the need to incorporate studies on taxonomy, genetics and function of meiofaunal taxa into global change impact research

Sub-Tenon's local anaesthesia for the treatment of retinopathy of prematurity with diode laser.

PURPOSE: To evaluate the safety and efficacy of sub-Tenon's local anaesthesia (LA) for laser treatment of threshold retinopathy of prematurity (ROP). METHODS: A cohort of 18 eyes of 10 neonates with threshold ROP was treated with diode laser peripheral retinal ablation over 14 treatment sessions using oral sedation and sub-Tenon's anaesthesia. Treatment was performed in a neonatal unit. The heart and respiratory rate, trans-cutaneous oxygen saturation, and physical activity were continuously monitored for signs of neonatal distress. Cardio-respiratory stability during and after the procedure was scored for each eye treated using a Cardio-respiratory index described previously. RESULTS: In all cases, the planned dose of laser was delivered. One out of 18 eyes developed stage 4b tractional retinal detachment over a follow-up of at least 6 months for all babies. Systemic complications during treatment included transient bradycardia and apnoea requiring stimulation in two babies and excessive head mobility in three babies. Treatment duration varied between 20 and 80 min. Ocular complications were conjunctival haemorrhage and chemosis. The mean cardio-respiratory index was 1.13, which compared favourably with the standard published. CONCLUSIONS: Sub-Tenon's LA with oral sedation appears to be a safe and effective alternative to general anaesthesia for laser treatment of ROP, with the potential for lower morbidity