ABSTRACT
The threat of the COVID-19 pandemic has persisted unabated over the past two years. The current response to maintaining public health has been guided by the vaccination of the population. The success of this policy has been mixed COVID coming back in each region in waves driven by new variants. Given that boosted immune response to COVID-19 owing to the vaccine also having an expiration time, it is important to look at alternative options to protect against COVID-19. In this regard, bioactive substances commonly found in food or food additives present a viable option to shield against consequential COVID-19 infection. We investigate 10 bioactive plant products for possible antiviral use against the SARS-CoV-2 virus, which causes COVID-19 infection. We test these compounds by in silico docking to the Spike glycoprotein, one of the major determinants of COVID-19 infection. The AutoDock Vina software was used to scan and score the docking sites on a Spike protein ectodomain model. The top twenty hits were saved for each of the ten compounds and then the common and unique docking sites were delineated noting the putative binding affinity in each case. The results show that all ten plant products are high-affinity binders to the Spike protein, the S2 domain being the primary binding site. Very few binding interactions are found on the receptor binding domain, which means that topically used of these molecules such as in nasal spray would not be effective. In the ingestible form, the compounds can bind to the Spike molecule and disable it from driving virus-host fusion, its main function. It can thereby limit the cell-to-cell spread of the virus thus enforcing localization and clearance by the host immune system.
ABSTRACT
Purpose : During the COVID-19 pandemic, in line with the UK Royal College of Ophthalmologists' (RCOphth) guidelines, anti-VEGF treatment regimens for Neovascular Age Related Macular degeneration (nAMD) were adjusted to 8 weekly Aflibercept injections with no clinic review. New patients and those who mentioned a significant drop of vision during their injection visits had OCT and their management adjusted to 4 weekly injections. This work audits our practice at a tertiary university hospital during the 2020 pandemic. Methods : Retrospective electronic data was collected from the Medisoft ophthalmology database for patients with nAMD, who received Aflibercept over a 5 month period from 01.03.2020 to 01.08.2020. Best Corrected Visual Acuity (BCVA), Central Macular Thickness (CRT), and number of injections were collected, and compared with our previously published year one data of 225 treatment naïve eyes of 223 patients with nAMD, treated with 8 weekly Aflibercept with mean BCVA of 61 letters & mean CRT of 235 μm at month 5 of therapy. We also assessed the clinical outcomes of our patients who received 4 weekly Aflibercept injections. Statistical analysis was done using SPSS version 24. Results : 1778 eyes of 1427 patients met the inclusion criteria and were included in the study. 1338 patients (93.8%) received 8 weekly injections, their mean BCVA ± SD was 59.7 ± 17.3 with CRT of 239.3 μm ± 67.2 SD at baseline and their latest BCVA ± SD was 59.3 ± 17.4, with CRT of 231.8 μm ± 73.8 SD. More than one third of them 618 (43.3%) received three injections during that period. 89 of our patients (6.2%) received 4 weekly injections during our study period. Their mean BCVA ± SD was 60.5 ± 17.6 with CRT of 276.1 μm ± 96.4 SD at baseline and their latest BCVA ± SD was 62.3 ± 15.1, with CRT of 247.8 μm ± 49.0 SD. Conclusions : Reassuringly, during the COVID-19 pandemic, patients on a fixed 8 weekly Aflibercept pathway maintained their vision. Their mean BCVA & CRT were comparable to our pre-COVID audit outcomes with a treat and extend protocol. Patients on 4 weekly injections also maintained their vision during the pandemic. RCOphth COVID guidelines allowed AMD patients to receive effective therapy whilst minimizing time in hospitals and permitted ophthalmologists to do other COVID related tasks.
ABSTRACT
Purpose : Diabetic macular oedema (DMO) is the comments cause of vision loss in patients with diabetes. As per the Royal College of ophthalmologist of the UK guidelines during the 2020 COVID-19 pandemic, in an effort to reduce injection and clinic visit frequency, and to minimize the risk of exposure of patients and healthcare staff many patients attending the eye unit had their appointments and treatment postponed. Patients diabetic retinopathy were offered clinic review and treatment during this time but many of these patients chose not to attend their appointments because they were at high risk from the virus. To evaluate the impact of delays in anti-VEGF treatment during the pandemic at a single university hospital clinic. Specifically, to identify the gap in treatment, and to examine the impact of this on visual acuity and anatomical outcomes. Methods : Retrospective data collection from the electronic medical record system (medisoft ophthalmology), and OCT scans of patients with DMO. Patients were included if they have active diagnosis of DMO with Anti-VEGF treatment in the 12 weeks prior to national lockdown and restriction of services. Exclusion criteria included patients with no follow up visits. Results : Average gap in treatment is16.5 (range) weeks and Average reduction of the best corrected visual acuity from last recorded before treatment gap to visual acuity when patient was reviewed, or treatment restarted was -0.15. (P > 0.05). One patient showed progression of his diabetic retinopathy to proliferative stage. Conclusions : Information was gathered for 328 patients (125 F, 203 M), who were treated with Anti-VEGF between 01/01/2020 & 01/09/2020 Preliminary data analysis of 134 eyes of 105 consecutive patients showed average gap in treatment of 13.2 (10-31) weeks. The average reduction of the best corrected visual acuity from last recorded before treatment gap to visual acuity when patient was reviewed, or treatment restarted was -0.05 LogMar. (P > 0.05) with mean VA 0.4 (range 0-1.6 LogMar) pre break and mean VA post treatment of 0.45 LogMar (range 0.06-1.6). 27/134 lost 5 letters or more of vision, 6 eyes lost 15 letters, 63 were within +/-5 letters of baseline vision. One patient showed progression of his diabetic retinopathy to proliferative stage, and two patients showed improvement in their DMO after their treatment gap, and their Anti-VEGF treatment was stopped.