COVID-19 and ophthalmology practice at University Hospital “Policlinico Umberto I” in Rome

COVID-19 is a newly defined disease, affecting the respiratory system. It is caused by a novel coronavirus, called Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2). The growing importance of the outbreak led the World Health Organization (WHO) to declare it a public health emergency of international concern on 30 January 2020 and to later officially describe it as a pandemic on 11 March 2020. Italy was the first European country to be heavily impacted by COVID-19, with the number of cases and deaths caused by the virus surging in the months of March and April 2020. Ophthalmologists represent a high-risk category for the spread of the infection, mainly because the examination demands close contact with the patient, exposing the clinician to tear, conjunctival secretions and to aerosol droplets

Efficacia di una terapia senza bendaggio con gel a base di trealosio ialuronato sodico carbomero, nella riparazione del danno corneale epiteliale di tipo meccanico vs terapia a base di pomata antibiotica oftalmica con bendaggio

Introduzione: la superficie oculare è una complessa unità funzionale, il cui normale funzionamento è regolato dal sistema nervoso, particolarmente espresso a livello corneale. Diverse patologie possono portare ad una alterazione della superficie oculare e tra queste le patologie traumatiche della superficie oculare. In caso di trauma lo scopo principale della terapia della superficie oculare è di riparare il danno epiteliale. L’effetto protettivo e riparativo di una formulazione in gel a base di trealosio/ialuronato sodico/carbomero può trovare una valida applicazione nei processi di riparazione di danno epiteliale. Scopo: valutare l’efficacia riparativa nei confronti del danno epiteliale di tipo meccanico, di una formulazione in gel a base di trealosio/ialuronato sodico/carbomero, senza bendaggio oculare in confronto ad una terapia topica antibiotica con bendaggio oculare. Materiali e metodi: studio osservazionale condotto su 262 pazienti afferiti presso la clinica Oculistica di Roma nel periodo maggio 2014 – giugno 2017 per una lesione corneale e/o corneo-congiuntivale di natura da corpo estraneo o per abrasione corneale traumatica. È stata ottenuta l’approvazione del Comitato Etico ed il consenso informato dei pazienti. Il primo gruppo era costituito da 158 pazienti sottoposti a rimozione di corpo estraneo corneale e trattati per 7 giorni con le seguenti modalità: 83 pazienti con una formulazione in gel a base di trealosio/ialuronato sodico/carbomero quattro volte al giorno senza bendaggio oculare; 75 pazienti con una terapia topica antibiotica quattro volte al giorno con bendaggio oculare. Il secondo gruppo costituito da 104 pazienti con abrasione corneale e trattati con le stesse modalità descritte nel primo gruppo di pazienti (50 vs 54 rispettivamente). Risultati: dopo 4 giorni di trattamento la percentuale di guarigione dei pazienti trattati con la formulazione in gel a base di trealosio/ialuronato sodico/carbomero rispetto ai pazienti trattati con terapia topica antibiotica era significativamente superiore in entrambi i gruppi (73% vs 32%; p<0,01 Gruppo 1) (78% vs 29%; p<0,01 Gruppo 2). La differenza si è mantenuta anche dopo 7 giorni di trattamento (98% vs 91%; p<0,01 Gruppo 1) (100% vs 87% Gruppo 2; p<0,01). Una differenza statisticamente significativa dopo 4 giorni di trattamento è stata riscontrata per i parametri soggettivi come dolore (0,22 vs 0,47; p<0,01 Gruppo 1) (0.1 vs 0.5; p<0,01 Gruppo 2), bruciore (0,23 vs 0,79; p<0,01 Gruppo 1) (0.1 vs 0.8; p<0,01 Gruppo 2) e sensazione di corpo estraneo (0,51 vs 1,37; p<0,01 Gruppo 1) (0.4 vs 1.8; p<0,01 gruppo 2). Conclusioni: la terapia con una formulazione in gel a base di trealosio/ialuronato sodico/carbomero senza bendaggio sembra una valida alternativa all’applicazione di pomata oftalmica antibiotica con bendaggio.Introduction: The ocular surface is a complex functional unit whose normal functions are regulated by the nervous system, particularly expressed at the corneal level. Various diseases, and also traumatic injuries, can lead to the alteration of the ocular surface. In case of trauma, the main purpose of ocular surface therapy is to repair the epithelial damage. A gel formulation based on trehalose/sodium hyaluronate/carbomer may represent a valid strategy to help the epithelial repair processes, thanks to its protective and repairing action. Aim: To evaluate the effect of a gel formulation based on trehalose/sodium hyaluronate/carbomer without eye patching compared to topical antibiotic therapy with eye patching, in recovering epithelial damage caused by mechanical injury. Materials and methods: An observational study involving 262 patients referred to the Ophthalmology Clinic in Rome between May 2014 and June 2017 for corneal and/or cornealconjunctival lesion caused by a foreign body or by traumatic corneal abrasion. Ethical approval was obtained , and only consenting subjects were involved. The first group involved 158 patients who underwent corneal foreign body removal and were treated for 7 days as follows: 83 patients received a gel formulation based on trehalose/sodium hyaluronate/carbomer four times a day, without occlusive eye patch; 75 patients were treated with topical antibiotic therapy four times a day and occlusive eye patch. The second group included 104 patients with corneal abrasion who underwent the same treatments described for the first group of patients (50 vs 54 patients, respectively). Results: After 4 days of treatment, the recovery rate was significantly higher in both groups of patients treated with the gel formulation based on trehalose/sodium hyaluronate/carbomer, compared to patients treated with topical antibiotic therapy (73% vs 32%, p<0.01; Group 1) (78% vs 29%, p<0.01; Group 2). The difference was maintained even after 7 days of treatment (98% vs 91%, p<0.01; Group 1) (100% vs 87%, p<0.01; Group 2). A statistically significant difference was found after 4 days of treatment in subjective parameters such as pain (0.22 vs 0.47, p<0.01; Group 1) (0.1 vs 0.5, p<0.01; Group 2), burning sensation (0.23 vs 0.79, p<0.01; Group 1) (0.1 vs 0.8, p<0.01; Group 2) and foreign body sensation (0.51 vs 1.37, p<0.01; Group 1) (0.4 vs 1.8, p<0.01; Group 2). Conclusions: Treatment with a gel formulation based on trehalose/sodium hyaluronate/carbomer without occlusive patch seems a valid alternative to the application of an antibiotic ophthalmic ointment and occlusive eye patching

Effects of scleral contact lenses for keratoconus management on visual quality and intraocular pressure

Purpose: To evaluate the visual acuity level achieved by scleral contact lens (CL) fitting in patients affected by keratoconus and to evaluate possible intraocular pressure (IOP) changes during the scleral CL wear using a transpalpebral tonometer. Methods: In a prospective case series a comparison was made between visual acuity obtained with glasses, RGP and 16.8mm diameter scleral CL in 30 consecutive patients affected by keratoconus. IOP was tested during scleral CL wear by transpalpebral Diaton Tonometer (DT) and also by Goldmann Applanation Tonometer (GAT) before and after scleral CL wear. Results: The mean logMAR visual acuity improved from 0.2±0.25SD with glasses and 0.1 ±0.02SD with RGP, to -0.002±0.041SD when using the scleral CL (p<0.05). The mean IOP value before scleral CL wear was 12.93mmHg±2.20SD when measured with GAT and 7.85mmHg±2.27SD when measured with DT. During scleral CL wear, IOP was assessed through DT, with a mean value of 8.86mmHg±2.36SD; values were stable after 8 hours of scleral CL use. Immediately after scleral CL removal, the mean IOP measured with GAT was 12.85mmHg ±2.40SD and the mean IOP measured with DT was 7.66mmHg±1.88SD. Therefore, during scleral CL wear, it was evidenced a small but statistically significant increase of the mean IOP value (1.01mmHg; p<0.01), with a reversion to values prior to application when scleral CL was removed. Conclusion: Scleral CLs remarkably improved visual acuity in keratoconus patients when compared to glasses or RGP contact lenses. Even if it was evidenced a small increase of the mean IOP value during their wear, it may not be significant in otherwise healthy eyes. Statistical analysis demonstrated good agreement between GAT and DT but their numerical values presented a constant gap, that should be taken into account when there is a need to relate the DT values to the reference ones

Improving keratoconus management with central corneal regularization and corneal collagen cross-linking protocol treatment

Purpose. To evaluate safety and efficacy of customized central corneal regularization (CCR), together with simultaneous accelerated corneal collagen cross-linking (A-CXL) - CCR-CXL protocol, to treat keratoconus-related corneal ectasia. Design. Retrospective, comparative observational case series. Methods. Patients that had undergone combined CCR-CXL protocol. Main inclusion criteria were keratoconus visual acuity deterioration and contact lens intolerance. All patients underwent complete ophthalmological evaluation, corrected distance visual acuity (CDVA) and Scheimpflug-corneal tomography. Central corneal regularization was performed by ablation using flying spot laser. Subsequently, the stroma was saturated with 0.17% riboflavin-5-phosphate added every 2 minutes, followed by A-CXL 9 mW/cm2 for 10 minutes. CDVA, medium keratometry value (Kmed), and total corneal morphological irregularity index (CMI) of patients were analyzed before surgery and after 1, 3 and 12 months. A P value of.05 or less was considered statistically significant. Results. 46 eyes of 39 keratoconus patients were treated. At 1 month, the mean CDVA (LogMar) increased from 0.19 ± 0.02 to 0.12 ± 0.02 (P < .05), and the difference remained stable at month 12. Kmax decrease was statistically significant from 57.02 ± 5.65 to 50.21 ± 4.48 (P < .05). CMI decreased significantly from 47.8 ± 2.84 to 30.1 ± 2.4 (P < .01). Conclusions. CCR-CXL protocol is safe and effective in arresting keratectasia progression and increasing corneal optic regularity in keratoconus. These findings showed a significant improvement in CDVA, keratometry values and corneal optical aberrations after being treated with the CCR-CXL protocol. Copyright © Società Editrice Universo (SEU

Janus kinase inhibitors: a new tool for the treatment of axial spondyloarthritis

Axial spondyloarthritis (axSpA) is a chronic inflammatory disease involving the spine, peripheral joints, and entheses. This condition causes stiffness, pain, and significant limitation of movement. In recent years, several effective therapies have become available based on the use of biologics that selectively block cytokines involved in the pathogenesis of the disease, such as tumor necrosis factor-α (TNFα), interleukin (IL)-17, and IL-23. However, a significant number of patients show an inadequate response to treatment. Over 10 years ago, small synthetic molecules capable of blocking the activity of Janus kinases (JAK) were introduced in the therapy of rheumatoid arthritis. Subsequently, their indication extended to the treatment of other inflammatory rheumatic diseases. The purpose of this review is to discuss the efficacy and safety of these molecules in axSpA therapy

Advances in the pathogenesis and treatment of systemic lupus erythematosus

Systemic lupus erythematosus (SLE) is a genetically predisposed, female-predominant disease, characterized by multiple organ damage, that in its most severe forms can be life-threatening. The pathogenesis of SLE is complex and involves cells of both innate and adaptive immunity. The distinguishing feature of SLE is the production of autoantibodies, with the formation of immune complexes that precipitate at the vascular level, causing organ damage. Although progress in understanding the pathogenesis of SLE has been slower than in other rheumatic diseases, new knowledge has recently led to the development of effective targeted therapies, that hold out hope for personalized therapy. However, the new drugs available to date are still an adjunct to conventional therapy, which is known to be toxic in the short and long term. The purpose of this review is to summarize recent advances in understanding the pathogenesis of the disease and discuss the results obtained from the use of new targeted drugs, with a look at future therapies that may be used in the absence of the current standard of care or may even cure this serious systemic autoimmune disease

Long term effect of air pollution on incident hospital admissions: Results from the Italian Longitudinal Study within LIFE MED HISS project

Background: The LIFE MED HISS project aims at setting up a surveillance system on the long term effects of air pollution on health, using data from National Health Interview Surveys and other currently available sources of information in most European countries. Few studies assessed the long term effect of air pollution on hospital admissions in European cohorts. Objective: The objective of this paper is to estimate the long term effect of fine particulate matter (PM2.5) and nitrogen dioxide (NO2) on first-ever (incident) cause-specific hospitalizations in Italy. Methods: We used data from the Italian Longitudinal Study (ILS), a cohort study based on the 1999–2000 National Health Interview Survey (NHIS), followed up for hospitalization (2001–2008) at individual level. The survey contains information on crucial potential confounders: occupational/educational/marital status, body mass index (BMI), smoking habit and physical activity. Annual mean exposure to PM2.5 and NO2 was assigned starting from simulated gridded data at spatial resolution of 4 × 4 km2 firstly integrated with data from monitoring stations and then up-scaled at municipality level. Statistical analyses were conducted using Cox proportional hazard models with robust variance estimator. Results: For each cause of hospitalization we estimated the hazard ratios (HRs) adjusted for confounders with 95% Confidence Interval (CI) related to a 10 μg/m3 increase in pollutants. For PM2.5 and NO2, respectively, we found positive associations for circulatory system diseases [1.05(1.03–1.06); 1.05(1.03–1.07)], myocardial infarction [1.15(1.12–1.18); 1.15(1.12–1.18)], lung cancer [1.18(1.10–1.26); 1.20(1.12–1.28)], kidney cancer [1.24(1.11–1.29); 1.20(1.07–1.33)], all cancers (but lung) [1.06(1.04–1.08); 1.06(1.04–1.08)] and Low Respiratory Tract Infections (LRTI) [1.07 (1.04–1.11); 1.05 (1.02–1.08)]. Discussion: Our results add new evidence on the effects of air pollution on first-ever (incident) hospitalizations, both in urban and rural areas. We demonstrated the feasibility of a low-cost monitoring system based on available data

Health communication in covid-19 era: Experiences from the italian vaccinarsì network websites

In 2013, in a bid to combat Vaccine Hesitancy (VH) and provide information on vaccines by communicating with the general public and the health community (e.g., healthcare workers and public health operators), the Italian Society of Hygiene and Preventive Medicine (S.It.I.) published the national website “VaccinarSì”. The project was subsequently extended to ten Italian Regions. This led to the creation of the VaccinarSì Network, whose websites are publicly owned. The aim of this work was to present the framework of the websites of the VaccinarSì Network and to analyse user behaviour in the pre-COVID-19-era (dating from each website’s publication until 31 January 2020) and in the COVID-19-era (from 1 February 2020 to 31 January 2021). Some metrics such as the number of visits to the site (sessions, number of users and average session duration), user behaviour (pages viewed, bounce rate and organic search) and the session acquisition path (direct traffic, referrals and social traffic) were searched, extrapolated and processed with Google Analytics. Qualitative and normally distributed quantitative variables were summarised with their absolute (relative) frequencies and means. Statistical differences between the means of the two periods were evaluated through paired t-test. A two-tailed p-value less than 0.05 was considered to be statistically significant. When the total values recorded over the period were compared, an overall increase in metrics was observed—the number of individual users, visits and individual pageviews rose in a statistically significant way. Our study aimed to highlight how combining disciplines such as health education and digital communication via Information and Communication Technologies (ICT) represents the best strategy to support citizens. This approach gives them the tools to become independent and responsible players that are capable of voluntarily and consciously choosing to adhere to vaccination programs. The VaccinarSì Network’s goal for the future is to reach an even wider audience. By building each user’s critical knowledge, this network enables users to be active components of a wider, more empowered community