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 hospital. 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.

COVID-19 related risk perception and altruistic response amongst undergraduates on reopening of educational institutes.

OBJECTIVE: To determine the coronavirus disease-2019-related risk perception and altruistic response among undergraduate medical students post-lockdown. Methods: The analytical cross-sectional study was conducted from October 1, 2020, to March 31, 2021, at the Baqai Medical University, Karachi, and comprised undergraduates aged 16 and above, studying in medical, dental, physiotherapy, pharmacy and Information technology departments. Data was collected using a structured and standardised online questionnaire. Positive responses led to a perceived risk score ranging 0-9, with a higher score indicating a greater perception of risk. The score was corelated with demographic variables. Data was analysed using SPSS 21. RESULTS: Of the 743 subjects, 472(63.5%) were females. The overall mean age of the sample was 21.34±1.8 years. The mean risk perception score was 3.8±2.5, and it was significantly associated with disease exposure (p<0.001). Altruism had a strong association with the perceived risk score (p<0.001), indicating lower risk perception. Conclusion: The risk perception among the students was low, pointing towards a need of psychological assistance programme for the students.

Hygienic Design of HVAC Systems for Hospitals

Hygienic design of the Air Handling Unit (AHU), the custom-designed industrial HVAC system used in hospitals, laboratories, and similar sterile areas to supply clean, filtered, and conditioned air, has become more prevalent during the covid-19 pandemic. Improper maintenance of the air handling system can carry germs or viruses at any stage. This study concentrates explicitly on Air Handling Units used in hospitals, which should maintain higher quality standards than conventional air handling systems to reduce all kinds of dirt, debris, mold, and bacteria from the system. Throughout the paper, the critical parameters and control points of the air handling units for hospitals are analyzed from a hygienic viewpoint, and the existing hygienic design standards are explained through an implemented case study.

SARS-2 lessons learned so far from Pakistan Perspective (A Review)

The COVID-19 outbreak started in December 2019, first from the China city, Wuhan. The rapid spread of the virus has affected the worldwide population involving 208 countries including UK, USA, Spain, Italy and Pakistan, and has been declared a global pandemic by the WHO. Strict measures have been taken globally to control the COVID-19 outbreak. With limited availability of resources, the government of Pakistan to different measures to prevent the spread, such as establishing screening and testing, isolation and quarantine facilities and training medical professionals and enforcing lockdown. Pakistan ranking 5th in the list of Populated countries and also being a developing country, requires financial aid as well as facilitation to combat the outbreak. Also overviewing the measures, proper hospital facilities are to be established and should be available in every region of the country, whereas the testing and screening facilities are required to be set as per the population of the country. The vaccines being introduced worldwide, its arrival in Pakistan and making it available for the population is also an effort made by the Government to bring back things to normal. Educating citizens and abiding by the safety rules to prevent the spread is still the area that needs to be worked upon. We have highlighted the measures and steps taken by the Pakistani government in last one year, to combat COVID-19 and to ensure the country’s safety and minimize mortality. [ FROM AUTHOR] Copyright of Professional Medical Journal is the property of Professional Medical Journal and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full . (Copyright applies to all s.)

An Evolutionary Belief Rule-Based Clinical Decision Support System to Predict COVID-19 Severity under Uncertainty

Accurate and rapid identification of the severe and non-severe COVID-19 patients is necessary for reducing the risk of overloading the hospitals, effective hospital resource utilization, and minimizing the mortality rate in the pandemic. A conjunctive belief rule-based clinical decision support system is proposed in this paper to identify critical and non-critical COVID-19 patients in hospitals using only three blood test markers. The experts’ knowledge of COVID-19 is encoded in the form of belief rules in the proposed method. To fine-tune the initial belief rules provided by COVID-19 experts using the real patient’s data, a modified differential evolution algorithm that can solve the constraint optimization problem of the belief rule base is also proposed in this paper. Several experiments are performed using 485 COVID-19 patients’ data to evaluate the effectiveness of the proposed system. Experimental result shows that, after optimization, the conjunctive belief rule-based system achieved the accuracy, sensitivity, and specificity of 0.954, 0.923, and 0.959, respectively, while for disjunctive belief rule base, they are 0.927, 0.769, and 0.948. Moreover, with a 98.85% AUC value, our proposed method shows superior performance than the four traditional machine learning algorithms: LR, SVM, DT, and ANN. All these results validate the effectiveness of our proposed method. The proposed system will help the hospital authorities to identify severe and non-severe COVID-19 patients and adopt optimal treatment plans in pandemic situations.