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Retina ; 43(3): 506-513, 2023 03 01.
Article in English | MEDLINE | ID: covidwho-2256274


PURPOSE: To investigate trends and the potential impact of the COVID-19 pandemic on the utilization of intravitreal antivascular endothelial growth factor (anti-VEGF) pharmaceuticals in an accountable care organization (ACO). METHODS: We retrospectively analyzed the Centers for Medicare and Medicaid Services beneficiary claims for all patients in the Houston Methodist Coordinated Care ACO registry during the years 2018, 2019, and 2020. RESULTS: Across the 3 years studied, a mean of 708 patients received anti-VEGF injections per year. The percentage of patients who received anti-VEGF injections decreased in each sequential year, with a steeper decline during the COVID-19 pandemic in the year 2020 (decrease by 0.4% from 2019 to 2020, P < 0.001; decrease by 0.2% from 2018 to 2019, P = 0.1453). The percentage of patients receiving bevacizumab of the total number of patients receiving any anti-VEGF treatment decreased (bevacizumab decreased by 6% from 2019 to 2020, P = 0.0174; decreased by 7% from 2018 to 2019, P = 0.0074). The COVID-19 pandemic did not seem to correlate with a change in the distribution of the specific anti-VEGF injection used. CONCLUSION: Despite the lower price which may correlate with value-based care, bevacizumab was the least used anti-VEGF treatment. COVID-19 correlated with a larger decrease in the utilization of all three anti-VEGF drugs.

COVID-19 , Ranibizumab , Humans , Aged , United States , Bevacizumab/therapeutic use , Ranibizumab/therapeutic use , Angiogenesis Inhibitors/therapeutic use , Vascular Endothelial Growth Factor A , Endothelial Growth Factors , Retrospective Studies , Pandemics , Receptors, Vascular Endothelial Growth Factor/therapeutic use , Medicare , Pharmaceutical Preparations , Intravitreal Injections , Recombinant Fusion Proteins
Mod Rheumatol Case Rep ; 2022 Dec 23.
Article in English | MEDLINE | ID: covidwho-2189398


We present a case of severe juvenile dermatomyositis (JDM) with limited response to steroids in an adolescent who developed symptoms within hours after receiving Pfizer BNT162b2 COVID-19 vaccine. The patient presented with severe weakness of proximal muscles, dyspnoea and tachycardia. His muscle enzymes were raised, and he was diagnosed with severe JDM following magnetic resonance imaging (MRI) and muscle biopsy. His management was challenging, requiring multidisciplinary input, and difficult decisions with regards to the appropriate immunomodulatory treatments. The patient had to undergo escalating immunosuppressive treatments before he began to recover clinically and biochemically. To our knowledge this is the first case in an adolescent, although a few cases of similar presentations following COVID-19 vaccination have been reported in adults. Elucidating the potential relationship of the vaccine with this severe myopathy in an adolescent is important for global vaccination policies but avoiding the conflation of association with causation is also crucial in the context of the pandemic.

Surv Ophthalmol ; 66(2): 354-361, 2021.
Article in English | MEDLINE | ID: covidwho-846634


The coronavirus (COVID-19) pandemic temporarily suspended medical student involvement in clinical rotations, resulting in the need to develop virtual clinical experiences. The cancellation of clinical ophthalmology electives and away rotations reduces opportunities for exposure to the field, to network with faculty, conduct research, and prepare for residency applications. We review the literature and discuss the impact and consequences of COVID-19 on undergraduate medical education with an emphasis on ophthalmic undergraduate medical education. We also discuss innovative learning modalities used from medical schools around the world during the COVID-19 pandemic such as virtual didactics, online cases, and telehealth. Finally, we describe a novel, virtual neuro-ophthalmology elective created to educate medical students on neuro-ophthalmology foundational principles, provide research and presentation opportunities, and build relationships with faculty members. These innovative approaches represent a step forward in further improving medical education in ophthalmology during COVID-19 pandemic and beyond.

COVID-19/epidemiology , Education, Medical, Undergraduate/methods , Internship and Residency/methods , Ophthalmology/education , Pandemics , Students, Medical , Telemedicine/methods , Curriculum , Humans