Influenza vs COVID-19: Its consequences and the interests of pandemics

The objective is to review the behavior of the COVID-19 pandemic vs. the Spanish Influenza pandemic as well as the 2009 pandemic and the last two epidemiological seasons (2019 and 2020), observed in our country, as well as some studies regarding to general and pediatric morbidity and mortality. And in the same way, reduce the emotional burden and the panic generated by various social and even health media, in all people who can read this paper. © 2023 Instituto Nacional de Pediatria. All rights reserved.

A case of post coronavirus disease 2019 (COVID-19) multisystem inflammatory syndrome in adults (MIS-A) presenting as fever and seizures

Background/Purpose: The coronavirus disease 2019 (COVID-19) pandemic has led to the emergence of a severe associated condition, multisystem inflammatory syndrome in adults (MIS-A). Initially identified in children as MIS-C, literature regarding the clinical manifestations, illness progression, and treatment of MIS-A are limited. Method(s): This study describes a case of MIS-A presenting as fever and seizures. She was initially given steroids and IVIG, and due to recurrence of fever, she was later treated with tocilizumab. Result(s): The patient was a 55-year- old Filipino female presenting to the emergency department with five days of fever, headache, and disorientation. Lumbar tap was done, which showed elevated opening pressure, normal leukocyte count, normal glucose, slightly elevated protein, and no microorganisms. She was admitted and managed as a case of viral encephalitis. On hospital day 6, she had sudden onset of head-jerking and further decrease in sensorium, hence she was transferred to the intensive care unit. Brain MRI was unremarkable, and subsequent immune-mediated encephalitis was considered. The patient underwent methylprednisolone pulse therapy and IVIG infusion, which provided immediate improvement of sensorium and resolution of fever episodes. Her condition stabilized, and she was transferred out of intensive care. She underwent physical and occupational rehabilitation as preparation for discharge. Two weeks after infusion therapy, on hospital day 26, patient had recurrence of fever episodes and persistence of elevated inflammatory markers. The patient had reported a previous COVID-19 infection 10 weeks prior to admission and received a booster dose of Moderna (Spikevax) COVID-19 vaccine three weeks prior. She tested positive for ANA (1:640, nuclear speckled), while the rest of the autoimmune antibody tests were negative. She was diagnosed as MIS-A based on the following: documented fever (>=38 degrees centigrade) for >=24 hours prior to hospitalization;new-onset neurologic signs and symptoms including seizures and encephalopathy in a patient without prior cognitive impairment;elevated CRP, ferritin, IL-6, and ESR;and a positive SARS-CoV- 2 test for recent infection by RT-PCR. Patient was treated with a locally available monoclonal antibody, tocilizumab, which was given on hospital day 43. Following infusion, she had lysis of fever and marked decrease in CRP, ferritin, IL-6, and ESR. Patient was discharged improved and without end-stage organ damage. Conclusion(s): Immunomodulators target hyperinflammation seen in MIS-A. There may be a role for the use of tocilizumab via blockage of IL-6. MIS-A remains a topic for research, particularly its disease characteristics, management, and relation to a dysregulated immune system.

Effectiveness of interventions for academic burnout among nursing students: A systematic review.

BACKGROUND: Nursing students experience higher stress and burnout compared to students in other health professions, with a prevalence rate of as high as 20%. More recently, they have been affected by changes in nursing education due to the COVID-19 pandemic, such as requirements for social isolation and distance learning. Although there are existing studies on interventions that address academic burnout among nursing students, there is no synthesis of randomized trials on this topic. AIM: This study aimed to systematically synthesize studies of interventions for academic burnout among nursing students. METHODS: A systematic search for randomized controlled trials was performed in PubMed, CINAHL, CENTRAL, Web of Science, and Scopus. Eligibility criteria were based on study directness in relation to the Patient, Intervention, Comparison, and Outcome (PICO) question. Two review authors independently screened articles for inclusion, collected data from the included studies, and performed risk of bias assessments using the Cochrane Risk of Bias Tool 2.0. A narrative synthesis was performed. This review was registered a priori in PROSPERO (CRD42022350196). RESULTS: Six papers were included in this review. Various interventions were studied: Qigong exercises, progressive muscle relaxation, autogenic therapy and laughter therapy, didactic behavioral sessions focusing on personal and professional development, and coping skills enhancement. The effects of these interventions on academic burnout, depression, and stress among nursing students were short term and their benefits over time remain uncertain. LINKING EVIDENCE TO ACTION: Progressive muscle relaxation and cognitive behavioral interventions demonstrated short-term positive effects on academic burnout, depression, and stress among nursing students. These findings may support the development of individual-level and organizational-level initiatives for nursing students aimed to lessen or prevent academic burnout. Large-scale, high-quality studies on the effect of interventions on academic burden in various settings and cultures are needed.

Prevention is better than healing: preliminary data from the Castelli-Early-CoV-19 (CEC-19) observational study

Background: Since April 2021, at Internal Medicine of Castelli Hospital started the administration of early anti-COVID-19 therapies. Materials and Methods: Initially only Monoclonal Antibodies (MAbs) were available;lately the oral antiviral (OA) therapy Molnupiravir. These drugs are reserved to positive patients, with recent symptoms onset and affected by risk factors for development of severe bilateral interstitial pneumonia. Results: 271 patients were treated with MAbs (M/F 142/129, median age 63, SD 13.87, IQR 18). Risk factors 50 patients obese (BMI>30), 187 with cardio-cerebrovascular diseases, 35 uncompensated diabetes mellitus, 83 chronic lung diseases, 45 immunosuppresed, 6 neurological disorders;105 had more than 1 risk factor. Until now, 196 patients reached one month follow-up;10 were hospitalized for COVID-19 complications, 7 discharged, 1 is still hospitalized, 2 died. Among the remaining 186 patients, 11 were still positive, but clinically recovered;the remaining 175 were healed and negative. To date 28 patients were treated with Molnupiravir (M/F 14/14, median age 64, DS 15.4, IQR 21). 8 obese, 21 cardio-cerebrovascular disorders, 10 chronic lung diseases, 3 uncompensated diabetes mellitus, 1 immunosuppressed. At one week follow-up no adverse effect nor hospitalization were reported. Conclusions: Early treatment of SARs Cov 2 appears to be well tolerated and able to avoid hospitalizations of patients at risk. This result allows us to hypothesize a saving of about 4500 € per patient treated with Monoclonals and about 5000 € with Antivirals treatment.

Focused library of phenyl-fused macrocyclic amidinoureas as antifungal agents.

The rise of antimicrobial-resistant phenotypes and the spread of the global pandemic of COVID-19 are worsening the outcomes of hospitalized patients for invasive fungal infections. Among them, candidiases are seriously worrying, especially since the currently available drug armamentarium is extremely limited. We recently reported a new class of macrocyclic amidinoureas bearing a guanidino tail as promising antifungal agents. Herein, we present the design and synthesis of a focused library of seven derivatives of macrocyclic amidinoureas, bearing a second phenyl ring fused with the core. Biological activity evaluation shows an interesting antifungal profile for some compounds, resulting to be active on a large panel of Candida spp. and C. neoformans. PAMPA experiments for representative compounds of the series revealed a low passive diffusion, suggesting a membrane-based mechanism of action or the involvement of active transport systems. Also, compounds were found not toxic at high concentrations, as assessed through MTT assays.

SARS-CoV-2 infection and cardiovascular disease: Analysis of hospitalized patients in high intensity care unit

Background and Aim: CoViD-19 patients with pre-exiting cardiovascular disease (CVD) are at the most high-risk for virus infection and developing severe disease. Pathophysiological mechanism is characterized by viral link to angiotensin-converting enzyme 2 (ACE2) and involvement of the endothelial system with the release of cytokines and direct damage of myocardium, microthrombosis, oxygen diffusion alterations. Aim of the study is to analyze clinical course and outcome in patients with pre-existing CVD. Materials and Methods: Out of 1100 patients admitted to Internal Medicine CoViD Unit of Castelli Hospital, ASL RM6, Lazio, Italy, we analyzed 602 M 330/ F 272, mean age 71 (M 69/F 74) with complete data set. Of 100 (M 58/F42) patients with pre-existing CVD were evaluated length of the stay (LOS), oxygen therapy, type of hospital discharge compared with all patients. Results: Most common CVD pathologies were heart failure (HF): 102 (M 45/F57), atrial fibrillation (AF): 31 (M19/F12), myocardial infarction (MI): 17 (M11/ F6) and associations among them. 100% of CVD patients underwent non-invasive ventilation (NIV). AF was linked with increased LOS (31 days) compared to HF (26 days) and MI (18 days). Overall LOS was 16,5 days. 36% of death patients had CVD. 67,4% (11,2% with CVD) were discharged at home, 43,6% (16,6% with CVD) transferred to step down care, and 9% to Intensive Care Unit. Conclusions: Timely identification and evaluation of patients with pre-existing CVD are fundamental for adequate treatment based on the severity and state of illness and for risk reduction.

Could the miniaturize techonologies improve patients adherence and assure better quality of life?

Background From 2000 to today, the use of information technology in the medical field is increasingly widespread, reaching a new milestone following the COVID 19 syndemia. It is increasingly evident that wireless monitoring allows patients to be followed more easily, detecting complications early at home and allowing to limit the contagion of healthcare personnel by reducing the interaction with patients in hospital rooms Methods A pilot Multicenter Open-label Randomized Controlled Trial (RCT) was performing comparing wearable wireless vital parameters continuous monitoring (WVPCM) system and regular monitoring. Data were collected to provide a clinical-economic impact (costs, program effectiveness and QALY gains) of complex patients (CPs) discharged from Internal Medicine Units. Cost were estimated by mean of the identification, measuring and valorisation of the resources uptake. Results 143 patients (37 M/38 F, mean age: 78.7 years). Major complications: respiratory failure detection (6,5 vs 3,8);reduction of sudden deaths (9.3% vs 16% experimental);care-related infections (6,5 vs 7,5), glycemic decompensation (4,3 vs 1,9). Hospital readmission within 21 days were 7% vs 11%. Relevant cost driver was time spent by nurses: 58 minutes/day/patient (vs 132) allow to save €54-90/patient. One way and multiway sensitivity analyses confirmed the robustness of our results with nearly 99% of the replications involved Conclusions WVPCM, detecting early complication during the post-discharge CPs monitoring, may facilitate a timely response ensuring a more appropriate management of complex patients seen (>25% of total admissions), reduce the time to diagnosis, improve efficiency/efficacy of disease management and reduce unnecessary clinic visits and hospital (re)admissions. The miniaturized technologies can improve patient adherence and assure better quality of life. WVPCM allows patients to be sent home safely and to effectively integrate Hospital and Community services. Key messages Wearable wireless vital parameters continuous monitoring (WVPCM) system reduce time and cost of nursing. Wearable wireless vital parameters continuous monitoring (WVPCM) system can detect early complication improve patient adherence and assure better quality of life.

What is the burden of aspergillosis and other opportunistic fungal infections in patients with severe influenza and COVID-19 in the ICU?

BackgroundCo-infection with Aspergillus previously described to cause significant morbidity and mortality in those with severe Influenza, has more recently been described in COVID-19. ‘Influenza-Associated Pulmonary Aspergillosis’ (IAPA) and ‘COVID-Associated Pulmonary Aspergillosis’ (CAPA) have been reported in up to 23% and 35% of severe disease, respectively. Establishing evidence of invasive Aspergillosis (IA) in these patients is challenging, requiring specific clinical, radiological and microbiological criteria. The burden of IAPA and CAPA in the ICU in our region is unknown.AimsTo identify the incidence of invasive Aspergillosis (IA) and other opportunistic fungal infection in those with severe Influenza and COVID-19 in a district general hospital, Fife, Scotland.MethodsRetrospective cohort review of ICU admissions with severe Influenza or COVID-19 from May 2017 - February 2021. IA was diagnosed using international definitions according to EORTC/MSG, AspICU and modified AspICU criteria.Results89 patients were identified with Influenza (27;median age 53.3 yrs, male 56%) and COVID-19 (62;median age 59.1 yrs, male 61%). No case satisfied criteria for definite IA, however, the majority of patients did not undergo all relevant tests;CT imaging features in 26/89 (29.2%), and fungal biomarkers in 3/89 (3.4%). Two patients demonstrated Aspergillus culture from respiratory samples but did not meet other criteria. Fungal infections were identified in 39/89 (44%), the majority Candida (37), mostly from ET secretions (54%). Candida was significantly higher in COVID-19 than in Influenza, including 2 patients with Candidaemia. Positive fungal culture was associated with increased length of stay (43d vs 20d), ICU bed days (26d vs 19d), but not mortality (33.3% vs 30.0%). Few patients (7.9%) received antifungal treatment, with possible explanations including unclear diagnosis, high costs, uncertain benefit. 54/89 (60.7%) demonstrated bacterial co-infection, including 31/89 (34.8%) with bacteraemia (COVID, 23;Influenza, 8).ConclusionsIAPA and CAPA were not identified in this 4-year cohort, although case finding was limited by inadequate diagnostics. Timely access to fungal biomarkers compromises diagnostic testing. The incidence is likely to be low, despite the significant study limitations. We recommend prospective systematic practice of investigations and improved fungal diagnostics to better understand the burden of Aspergillosis in these patients.

Refractory acute disseminated encephalomyelitis-like findings in a pediatric patient in the setting of SARS-CoV-2 with histopathology

Objective: 5-year-old boy with ADEM-like syndrome in the setting of SARS-CoV-2. Background: Acute disseminated encephalomyelitis (ADEM) is an autoimmune demyelinating syndrome of the central nervous system that usually occurs following a febrile illness. Severe acute respiratory syndrome coronavirus 2 (SARS-CoV2) is predominantly a respiratory disease, but it is becoming increasingly recognized to have neurological manifestations. There have been few reported cases of ADEM in adults related to SARS-CoV-2, but none in the pediatric population. Design/Methods: Clinical course, neuroimaging, and histopathology results description. Results: A 5-year-old boy presented with 3 weeks of headaches, blurry vision, and emesis. Initial evaluation was unremarkable except for positive SARS-CoV-2 RNA PCR from nasopharyngeal swab. Patient returned to the ED for persistent symptoms. MRI brain demonstrated supratentorial and infratentorial enhancing lesions, with vasogenic edema and punctate hemorrhage foci, and bilateral optic nerve swelling. MRI spine revealed longitudinally extensive myelitis. Brain biopsy was pursued showing foci of lymphohistiocytic perivascular inflammation consistent with a meningoencephalitis. ADEM was suspected and high dose intravenous methylprednisolone was initiated. CSF revealed lymphocytic pleocytosis. Extensive evaluation including Myelin oligodendrocyte glycoprotein and Aquaporin-4 antibodies was unremarkable. Given limited clinical improvement, patient received 5 sessions of plasmapheresis with improvement. He returned a week later with headache. Repeat MRI brain revealed mild hydrocephalus. He received a 5-day course of high dose steroids followed by 6-week steroid taper. Patient remained clinically stable, however, surveillance MRI brain 2-months later revealed worsening cerebellar edema and hydrocephalus so he received another 5-day course of steroids and intravenous immunoglobulins. Conclusions: This is the first presentation to our knowledge of pediatric ADEM-like in the setting of SARS-CoV-2 with a medically refractory course. This case highlights the importance of recognizing neurological manifestations of SARS-COV-2. Given the novelty of the virus, the inflammatory process triggered by this infection may follow a different clinical course, therefore close monitoring is recommended.

Impacto de la segunda ola de infección de covid-19 en pacientes de hemodiálisis extremadura (España)

BACKGROUND AND AIMS: Hemodialysis patients are high-risk patients for severe forms of SARS-Cov 2. Extremadura has two provinces Badajoz(B) and Caceres(C) with one million of people. The incidence was small in the first part of the pandemic (2,6%) compared with the national incidence, and it was higher in C than in B (5,6% vs 1,1%) The aim of this study was to estimate the incidence of COVID-19 disease in the population of Extremadura's hemodialysis patients and to study the clinical evolution, treatment and mortality in patients with confirmed infection with Polymerase chain reaction(PCR) during the second wave. METHOD: Multicenter, retrospective, observational study of hemodialysis patients with COVID-19 disease between August and December of 2020. There were 683 hemodialysis patients in this period distributed in 5 hospital units and 7 out of hospital Units. RESULTS: Incidence: 6,8% (46 infected of SARS-Cov 2), with almost one patient in each center (the highest with 16,1%) and higher incidence in B than in C (8,1% vs 4,1%). Males (58,7%), media age, (69,3±11,9) and median renal replacement therapy time 29 months (RIC 47,4). The most frequent CKD was diabetic nephropathy (16%), but 35% of the patients have diabetes, 86% hypertension and 56% cardiovascular illness. Treatment with angiotensin-converting enzyme inhibitors and angiotensin II receptor blockers 40% and with vitamin D 62,8%. There were 42% patients who had contacted with positive people of hemodialysis unit and 37% with positive people outside. 67% have symptoms: the most frequent cough and fever (46%). Hospitalized patients: 41,6%, all of them with bilateral pneumonia. All had lymphocytopenia and high acute phase reactants: D-dimer 1195 ng/ml (RIC 1545), Ferritin 950,12ng/ml (RIC 533,6) IL-6 30,11pg/ml (RIC 41,13) C-reactive protein 28 mg/l (RIC 62,10) Procalcitonin 0,42 ng/ml (RIC 0,44), all increased in the hospitalized period without significant differences. Median hospitalized time was 10 days (RIC 11). Nine patients died (19,5%), 3 of them in intensive unit care with 15 days median. Most of them needed antibiotic therapy, steroids and anticoagulation, 5 convalescent plasma and 5 tocilizumab. We stopped isolated room dialysis when they had negative PCR (56%) or IgG positive (54%), median insulation 17 days (RIC 7). We haven't found differences in hospitalized vs no hospitalized patients in age, gender, renal replacement therapy time, etiology, DM, hypertension or cardiovascular illness and treatment, nor in relation with mortality. CONCLUSION: We have observed an increase in the incidence of infection in this period compared with the first period of the pandemic, parallel to the increases in the incidence of the general population in Extremadura (more in B than in C). The mortality is high but similar to other publications. We have to do screening due to the possibility of asymptomatic patients that could have contributed to expand the infection. The high number of hospitalized patients and the need of isolated rooms dialysis for infections patients is a challenge for the organization of hemodialysis units but having positive serologic reduce the isolation time.

Characteristics and outcome of adults with acute lymphoblastic leukemia and COVID 19 infection in the first vs. Second epidemic wave in Spain: A study from the Pethema and Geth groups

Background: SARS-CoV-2 infection has bimodal distribution in Europe with a 1st wave in March-June 2020 and a 2nd in September 2020-February 2021. In cancer patients (pts) the lethality of COVID- 19 infection was 25%>35% in the 1st wave. Comparison on impact of COVID-19 infection in the 1st vs. 2nd waves have not been performed in ALL. Aims: We compared the frequency, clinical characteristics and outcome of adults with ALL and COVID-19 infection in the 1st vs. 2nd waves in Spain. Methods: Between March 1, 2020-May 31, 2020, and between September 12, 2020- January 12, 2021 (date of vaccination onset in Spain), a registry from the PETHEMA (Programa Espa.ol de Tratamientos en Hematologia) and GETH (Grupo Espa.ol de Trasplante Hematopoyético y Terapia Celular) groups prospectively recruited adult ALL pts with COVID-19 infection confirmed by PCR. Demographic and clinical characteristics of ALL and COVID-19 infection, comorbidities, treatment and outcome were collected and compared in the two periods. In addition, prognostic factors for survival were analyzed. Results: Fifty-six patients were collected in 82 centers contacted, 4 of them being excluded (COVID infection >3 yr. after end of ALL therapy [n=3] and Burkitt lymphoma [n=1]). Twenty-eight pts were collected in the 1st wave and 24 in the 2nd. Median age was 46 (range 20-83), (34 pts [65%] >40 yr). Comorbidities were present in 18 pts (35%). ALL was of B-cell precursors in 38 pts (74%) (Ph+ in 8, 15%). Thirtyone pts (60%) were under frontline treatment, 16 (31%) in rescue, 1 (2%) palliative and 4 (7%) had recently finished the therapy. Eight pts had received allogeneic HSCT (5 of them at COVID-19 infection diagnosis), CAR T (n=1, 2 yr prior to COVID-19 infection) or received immunotherapy (inotuzumab, n=6, 2 at COVID-19 infection, and blinatumomab, n=1, prior to COVID-19 infection). Eleven pts were receiving immunosuppressive drugs at COVID infection (fludarabine in 6, among others). No significant differences were observed in ALL characteristics in the two COVID-19 waves, except for a significantly higher number of patients on first line therapy in the second wave, and a higher frequency of severe neutropenia and lymphocytopenia in the first wave. COVID19 therapy was different in the two periods, with significantly higher use of hydroxychloroquine, remdesivir and lopinavir-ritonavir in the first wave and corticosteroids in the second wave. No significant differences were observed in need of oxygen support (12 vs. 8 pts), ICU requirement (7 vs. 4 pts), days in ICU (medians 16 vs. 21) and time to COVID infection recovery (medians 17 vs. 13 days). Seventeen patients (33%) died (11 vs. 6), being death attributed to COVID infection in 15 (29%), without significant differences in the 100-day survival probabilities (Figure 1). By multivariable analysis only comorbidities at COVID-19 infection had a negative impact on survival (HR: 5.358 [95% CI: 1.875;15.313]). Summary/Conclusion: COVID-19 infection was frequent in ALL pts, especially in those with advanced age and under ALL frontline or rescue therapy. The frequency of severe COVID-19 infection and mortality were high, with negative impact of comorbidities on survival. No significant differences were observed in ALL characteristics, response to therapy and outcome in the two waves of COVID infection. The poor outcome of COVID infection makes vaccination a priority for ALL patients in this pandemic period. Supported in part by 2017 SGR288 (GRC) Generalitat de Catalunya and "la Caixa" Foundation.

Implications on the scientific production of covid-19

The impact and the universality of the pandemic by SARS-CoV-2 has caused the need to have information quickly and accessible for the benefit of decision-making among healthcare professionals. In 10 months the scientific production on this new coronavirus has exceeded the number of 66 thousand articles, according to the LitCovid database, created by the National Library of Medicine, doubling and tripling every few weeks. This same urgency has characterized some of the main features of this voluminous production, in addition to its continuous and exponential growth, such as greater dissemination in open access and preprint repositories, a certain acceleration in the manuscript review process by editorials and an abundance of opinion articles, recommendations or comments compared to a smaller number of original articles with clinical data from large groups of patients.

Nutritional recommendations for taking care of infected people with COVID-19

On March 11th, 2020, the World Health Organization (WHO) declared the disease caused by the SARS-Cov2 virus, COVID-19, as a pandemic. The presentation can range from being asymptomatic or mild home care stages or isolation, to complicated forms in clinic rooms or requiring intensive care units. Obesity (especially, BMI >40 kg/m2) is relevant in this disease, being a strong independent predictor of hospitalization and aggravation, following age. Other comorbidities such as high blood pressure, diabetes and other cardiovascular diseases are also important in this context. The following article aims at evaluating and summarizing the different nutritional care recommendations published both by scientific societies and professionals from health institutions in different countries of the region and the world, as well as within our country. The implementation process of the nutritional plan must include not only those hospitalized, but also the people infected with mild forms. The nutritional care process must include four stages: nutritional status assessment, nutritional diagnosis, intervention and monitoring/evaluation of the results, with special attention to patients in the intensive care units. As there are no specific recommendations to date, it is suggested to adapt the current recommendations for the care of the elderly, hospitalized polymorbid patients and critically ill patients. The attention of these groups by nutrition professionals is imperative to adapt the diet to the symptoms and condition of each individual patient. In addition, discharge monitoring is essential, giving timely follow-up to recovery and rehabilitation of the nutritional status, especially of the muscle mass that may have deteriorated during hospitalization.

A Novel Virtual Wet Lab-Using a Smartphone Camera Adapter and a Video Conference Platform to Provide Real-Time Surgical Instruction.

PURPOSE: Proctored surgical instruction has traditionally been taught through in-person interactions in either the operating room or an improvised wet lab. Because of the COVID-19 pandemic, live in-person instruction was not feasible owing to social distancing protocols, so a virtual wet lab (VWL) was proposed and implemented. The purpose of this article is to describe our experience with a VWL as a Descemet membrane endothelial keratoplasty (DMEK) skills-transfer course. This is the first time that a VWL environment has been described for the instruction of ophthalmic surgery. METHODS: Thirteen participant surgeons took part in VWLs designed for DMEK skills transfer in September and October 2020. A smartphone camera adapter and a video conference software platform were the unique media for the VWL. After a didactic session, participants were divided into breakout rooms where their surgical scope view was broadcast live, allowing instructors to virtually proctor their participants in real time. Participants were surveyed to assess their satisfaction with the course. RESULTS: All (100%) participants successfully injected and unfolded their DMEK grafts. Ten of the 13 participants completed the survey. Respondents rated the experience highly favorably. CONCLUSIONS: With the use of readily available technology, VWLs can be successfully implemented in lieu of in-person skills-transfer courses. Further development catering to the needs of the participant might allow VWLs to serve as a viable option of surgical education, currently limited by geographical and social distancing boundaries.