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PURPOSE: To assess the impact of the measures taken during the lockdown period from March 17 to May 11, 2020 on the management of patients with exudative age related macular degeneration treated by intravitreal anti-VEGF injections at the University Hospital of Tours. METHODS: In this retrospective study, patients were included after analysis of the computerized medical records of patients with age related macular degeneration. Those who were treated for exudative age related macular degeneration who received at least 1 intravitreal injection in the 12 months prior and at least one consultation in the 6 months prior to the lockdown period, were included. The initial and final mean visual acuity were compared with a 5 letter non-inferiority margin. A subgroup analysis was performed according to outcomes. The visual acuities immediately after this period were also recorded. RESULTS: In all, 595 eyes of 493 patients were included. The mean initial visual acuity was 59.6 letters, vs. 58.5 for the final visual acuity, i.e. a difference of -1.13 letters with a lower limit of the confidence interval of less than 5. The visual acuity on release from lockdown was comparable to the other 2 measurements. Initial visual acuity and the number of missed treatments were the main factors associated with functional loss. CONCLUSION: Patients' visual acuity during the lockdown period was able to be maintained despite the restrictive measures and limitation of care access in France. The most common cause of substantial visual decline was missed intravitreal injections.
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COVID-19 , Macular Degeneration , Wet Macular Degeneration , Humans , Infant , Angiogenesis Inhibitors/therapeutic use , Ranibizumab , Follow-Up Studies , Retrospective Studies , COVID-19/epidemiology , COVID-19/prevention & control , Communicable Disease Control , Macular Degeneration/drug therapy , Macular Degeneration/epidemiology , Intravitreal Injections , Treatment Outcome , Wet Macular Degeneration/drug therapy , Wet Macular Degeneration/epidemiologyABSTRACT
Coronavirus disease 2019 (COVID-19) is a highly contagious disease caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). More than one-third of patients with COVID-19 experience neurological symptoms, including confusion, headaches, and decreased/disordered taste. Alzheimer's disease (AD) is a slowly progressive neurodegenerative disease and the most common type of dementia. Alzheimer's disease patients are at high risk and susceptible to infection with COVID-19, which may cause severe illness and even death. There appears to be an interaction between AD and COVID-19, and on the one hand, patients with COVID-19 seem to be more likely to develop AD. AD patients, on the other hand, may be more susceptible to severe COVID-19. Therefore, understanding the common link between COVID-19 and AD may help to develop treatment strategies. Risk factors common to AD and COVID-19 are aging, ApoE T4 allele, beta-amyloid (Abeta) deposition, angiotensin-converting enzyme (ACE), neuroinflammation, oxidative stress. Here, this article focuses on the relationship between COVID-19 and AD, explores common risk factors and potential pathogenesis, and provides help for early prevention, treatment and recovery.
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With the development of technology, doctors can diagnose and treat many diseases through telemedicine. At present, teleophthalmology is mainly used in screening and diagnosing some ocular diseases, monitoring chronic ocular diseases, as well as teleconsultation. With the increasing demand and application of teleophthalmology, some problems will gradually become prominent, such as insufficient equipment and staff, medical risks, patient acceptance and satisfaction, network security, privacy, and covering of medical insurance. The global pandemic of COViD-19 has unexpectedly brought telemedicine to the forefront of ophthalmic services, and may continue to change the way of ophthalmic diagnosis and treatment. With the development of artificial intelligence technology, the expansion of 5G communication network coverage, the standardized training of primary medical staff, and the introduction of relevant laws and regulations, teleophthalmology will become more improved, universal, and widely applied, so as to provide patients with sustainable medical services of higher quality.Copyright © 2021, Peking Union Medical College Hospital. All rights reserved.
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Purpose: To evaluate the epidemiologic pattern of intravitreal injections (IVIs) during Coronavirus Disease 2019 (COVID-19) pandemic. Methods: The records of patients receiving IVIs in two 12-month periods immediately before and after the beginning of the COVID-19 epidemic were included. Age, province of residency, indication, number of injections, and number of operating room (OR) visits were analyzed. Results: Compared to pre-COVID period, a 37.6% decrease in the number of patients receiving IVI in COVID period was seen (10518 vs. 6569). There was a parallel decrease in the number of OR visits (25590 vs. 15010: 41.4%) and injections (34508 vs. 19879: 42.4%). Regarding IVI indication, age-related macular degeneration (AMD) showed the highest decrease in IVI rate (46.3%) which was significantly higher than decrease in other indications (P < 0.001). Retinopathy of prematurity (ROP) patients showed no change after epidemic. Mean overall age in AMD group was the highest (67.7 ± 13.2 years) compared to other indication groups (excluding ROP) (P < 0.001); while the mean age of the other indications was not significantly different from each other (excluding ROP). Conclusions: COVID pandemic decreased the number of IVIs significantly. While previous studies suggested that the AMD patients had the highest risk of visual loss due to failure to receive IVIs in a timely manner, this very same group showed the highest decrease in the IVI number after pandemic. The health systems should devise strategies to protect this most vulnerable group of patients in future similar crises.
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The renin–angiotensin system is major endocrine, paracrine, and autocrine system that has a notorious role in regulating hemodynamics and electrolyte balance, thus controlling blood pressure. Nonetheless, the functions of RAS are multiple and continue to expand, as its receptors, enzymes, and peptides have been identified in different organs/tissues, implying novel local effects of RAS and participation in the pathogenesis of different diseases in multiple organs, including the eyes. Vascularized, fibrous, and nervous structures of the eyes and their fluids express several RAS components including angiotensinogen, prorenin, renin, (P)RR, ACE, Ang II, AT1R, AT2R, ACE2, Ang 1-7, and Mas. Additionally, abundant RAS hormones are present in intraocular tissues implicating local production. Ocular RAS functions seem to be diverse;first, RAS is proposed to modulate aqueous humor biosynthesis and drainage, consequently regulating IOP. Exacerbation of ACE/ Ang II/ AT1R actions is observed in glaucoma, and blockage of this axis with ACEIs and ARBs is a feature that can be explored to reduce IOP and treat glaucoma. Second, impairment of RAS with exacerbation of ACE/ Ang II/ AT1R and depletion of ACE2/ Ang 1-7/ Mas culminate in an angiogenic, inflammatory, proliferative, and oxidative phenotype, which is tightly related to retinal vascular disorders such as diabetic retinopathy, age-related macular degeneration, and retinopathy of prematurity. Indeed, treatments blocking ACE/ Ang II/ AT1R or enhancing ACE2/ Ang 1-7/ Mas are reported to be beneficial to prevent or restrain the progression of these diseases. Finally, clinical manifestations of COVID-19 include ocular disorders such as conjunctivitis, dry eyes, eye pain, discharge, and blurred vision. ACE2 expression in ocular tissues may define ophthalmic susceptibility to SARS-CoV-2 infection. Moreover, SARS-CoV-2 entry mechanisms may cause depletion of ACE2 biological effects, which can contribute to RAS dysregulation and the ocular disorders observed in COVID-19. This chapter focuses on reviewing the components and functions of the ocular RAS, its implications for eye homeostasis, and the potential of RAS as a therapeutic target to treat ocular disorders, including glaucoma, diabetic retinopathy, age-related macular degeneration, and retinopathy of prematurity. © 2023 Elsevier Inc. All rights reserved.
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The proceedings contain 40 papers. The topics discussed include: sex, bugs microwave attacks: how bad science, mating insects psychogenic illness created an international incident with Cuba;Covid-19 and neuropsychiatry;clinical update on delirium;fibromyalgia and myalgic encephalomyelitis/ chronic fatigue syndrome (ME/CFS): an interoceptive predictive coding model of pain and fatigue expression;when the spark goes out: the neurology of apathy and motivation;is subjective cognitive decline (SCD) a better marker of susceptibility to functional cognitive disorder (FCD) than to neurodegeneration?: the caerphilly prospective study;temporal and spectral dynamics of reward and risk processing in the amygdala revealed with stereo-EEG recordings in epilepsy;a systematic review of extra-motor symptom evaluation in clinical trials for amyotrophic lateral sclerosis;and stimulation of the ventrolateral prefrontal cortex speeds up evidence accumulation in conflictual-uncertain environments.
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Background The neurotrophic effects of Covid-19 are becoming increasingly recognized, with altered mental state now being the second most common presenting complaint insert numbers. A key question is whether this has long term consequences. Cognitive problems are commonly reported in patients 3 months after acute infection as part of the so called Long-Covid syndrome. However, the underlying cause is not well understood. Candidate explanations include legacy from encephalitis and stroke;however, other complications such as the sequelae, delirium, remain underexplored. Furthermore, little consideration has been given to functional cognitive disorders and the cognitive consequences of depression, anxiety and fatigue. Aims We propose a structured approach to clinical assessment for clinicians reviewing late cognitive complaints after COVID 19. Methods We created our own unique framework for neurocognitive Covid assessment based upon a review of the literature. Results Covid status- Any positive test. If not review of core symptoms such as breathlessness, headache, anosmia, nasal obstruction, cough, myalgia, or gustatory dysfunction;duration, extent of exposure to Covid confirmed cases. Consider rapid antibody testing. Neuropsychiatric history- Part 1 symptoms at onset- in particular disruptions of consciousness and altered mental state. Acute memory impairment, anterograde/retrograde and with/ without a temporal gradient. neurocognitive function. ITU admission and oxygen requirements. Part 2 Current cognitive and mental state- in addition to standard history seek evidence of internal inconsistency of memory symptoms and attentional dysregulation. Has social cognition and meta-cognition been affected. Note attribution bias i.e. no Im not depressed, I cant enjoy anything because of my symptoms Background history- subtle suggestion of neurodegeneration and depression, anxiety and functional symptoms should be explored. MRI findings- signal changes in the medial temporal lobe, nonconfluent multifocal white matter hyperintense lesions, and isolated white matter microhemorrhages. Novel biomarkers IL-6, MCP-1, and IP-10. Conclusion Cognitive symptoms are common after confirmed and assumed COVID exposure. We propose a framework for neuropsychiatric assessment and the use of adjuvant imaging and potential biomarkers.
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OBJECTIVES: The beneficial effects of ozone therapy consist mainly of the promotion of blood circulation: peripheral and central ischemia, immunomodulatory effect, energy boost, regenerative and reparative properties, and correction of chronic oxidative stress. Ozone therapy increases interest in new neuroprotective strategies that may represent therapeutic targets for minimizing the effects of oxidative stress. METHOD(S): The overview examines the latest literature in neurological pathologies treated with ozone therapy as well as our own experience with ozone therapy. The effectiveness of treatments is connected to the ability of ozone therapy to reactivate the antioxidant system to address oxidative stress for chronic neurodegenerative diseases, strokes, and other pathologies. Application options include large and small autohemotherapy, intramuscular application, intra-articular, intradiscal, paravertebral and epidural, non-invasive rectal, transdermal, mucosal, or ozonated oils and ointments. The combination of different types of ozone therapy stimulates the benefits of the effects of ozone. RESULT(S): Clinical studies on O2-O3 therapy have been shown to be efficient in the treatment of neurological degenerative disorders, multiple sclerosis, cardiovascular, peripheral vascular, orthopedic, gastrointestinal and genitourinary pathologies, fibromyalgia, skin diseases/wound healing, diabetes/ulcers, infectious diseases, and lung diseases, including the pandemic disease caused by the COVID-19 coronavirus. CONCLUSION(S): Ozone therapy is a relatively fast administration of ozone gas. When the correct dose is administered, no side effects occur. Further clinical and experimental studies will be needed to determine the optimal administration schedule and to evaluate the combination of ozone therapy with other therapies to increase the effectiveness of treatment.Copyright © 2021 Neuroendocrinology Letters.
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Objective: To elucidate the relationship between COVID-19 and neurodegenerative diseases. Background(s): Recently, the impact of the COVID-19 pandemic on patients with neurodegenerative disease, as well as the specific neurological manifestations of COVID-19 have aroused great interests. However, there are still many issues of concern to us that need to be clarified. Method(s): We reviewed the current literature on the complex relationship between neurodegenerative diseases [including Parkinson's disease (PD) and Alzheimer's disease (AD)] and COVID-19. We summarized the impact of COVID-19 infection on symptom severity, disease progression and mortality of neurodegenerative disease, and discussed whether COVID-19 infection could trigger neurodegenerative disease. The vulnerability to COVID-19 infection and prognosis of COVID-19 positive individuals in patients with neurodegenerative disease were also included. Modification of care strategy, specific drug therapies and vaccines during the pandemic were also listed. At last, mechanisms underlying the link between COVID-19 and neurodegenerative disease were reviewed. Result(s): There is an interaction between COVID-19 infection and neurodegenerative diseases, including worsening symptomatic severity and accelerating neurodegeneration by COVID-19 infection in PD and AD patients, and vice versa, neurodegenerative diseases increasing the vulnerability to COVID-19 infection and enhancing the risks of hospitalization and death after virus infection. Many potential molecular and cellular pathways were hypothesized to be the link between COVID-19 infection and neurodegenerative diseases, but further studies are still needed to verify the mechanisms. COVID-19 pandemic has profoundly changed the way of medical care, telemedicine, vaccines and specific drug therapies are promising for the better management of PD and AD patients [Table 1] [Table2]. Conclusion(s): COVID-19 and neurodegenerative diseases have reciprocal impact on each other.
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OBJECTIVES: To evaluate the outcomes of delayed intravitreal injections (IVIs) caused by the outbreak of coronavirus disease 2019 (COVID-19), in patients with neovascular age-related macular degeneration (nAMD). METHODS: nAMD patients with scheduled IVIs between March 1st and April 30th, 2020 were stratified through a risk-based selection into a non-adherent group (NA-group) if they skipped at least one IVI and an adherent group (A-group) if they followed their treatment schedule. During the pandemic visit (v0), if a significant worsening of the disease was detected, a rescue therapy of three-monthly IVIs was performed. Multimodal imaging and best-corrected visual acuity (BCVA) findings were evaluated after 6 months (v6), compared between groups and with the visit prior the lockdown (v-1). RESULTS: Two hundred fifteen patients (132 females, mean age: 81.89 ± 5.98 years) delayed their scheduled IVI while 83 (53 females, mean age: 77.92 ± 6.06 years) adhered to their protocol. For both groups, BCVA at v0 was significantly worse than v-1 (mean 4.15 ± 7.24 ETDRS letters reduction for the NA-group and 3 ± 7.96 for the A-group) but remained stable at v6. The two groups did not significantly differ in BCVA trends after 6 months and neither for development of atrophy nor fibrosis. CONCLUSIONS: A risk-based selection strategy and a rescue therapy may limit the long-term outcomes of an interruption of the treatment protocol in patients with nAMD.
Subject(s)
COVID-19 , Macular Degeneration , Wet Macular Degeneration , Aged , Aged, 80 and over , Female , Humans , Angiogenesis Inhibitors/therapeutic use , Communicable Disease Control , Intravitreal Injections , Macular Degeneration/drug therapy , Pandemics , Ranibizumab/therapeutic use , Treatment Outcome , Wet Macular Degeneration/drug therapy , MaleABSTRACT
BACKGROUND: Alcoholic cerebellar degeneration is a restricted form of cerebellar degeneration, clinically leading to an ataxia of stance and gait and occurring in the context of alcohol misuse in combination with malnutrition and thiamine depletion. However, a similar degeneration may also develop after non-alcoholic malnutrition, but evidence for a lasting ataxia of stance and gait and lasting abnormalities in the cerebellum is lacking in the few patients described with purely nutritional cerebellar degeneration (NCD). METHODS: We present a case of a 46-year-old woman who developed NCD and Wernicke's encephalopathy (WE) due to COVID-19 and protracted vomiting, resulting in thiamine depletion. We present her clinical course over the first 6 months after the diagnosis of NCD and WE, with thorough neuropsychological and neurological examinations, standardized clinical observations, laboratory investigations, and repeated MRIs. RESULTS: We found a persistent ataxia of stance and gait and evidence for an irreversible restricted cerebellar degeneration. However, the initial cognitive impairments resolved. CONCLUSIONS: Our study shows that NCD without involvement of alcohol neurotoxicity and with a characteristic ataxia of stance and gait exists and may be irreversible. We did not find any evidence for lasting cognitive abnormalities or a cerebellar cognitive-affective syndrome (CCAS) in this patient.
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Introduction: Varicella zoster virus is a highly infectious alpha-herpesvirus, pathogenic only to humans. The primary infection of varicella zoster virus causes chickenpox, which is contagious and primarily infects children and adolescents in India. Following the primary infection, the virus remains dormant in sensory root ganglia. Activation of the dormant virus in later stages of life causes herpes zoster infection which may vary from subclinical infection to typical zoster, scattered vesicles, zoster sine herpete or disseminated zoster, which depends on the individual's immune status. Case report: In this case series, we present two patients with herpes zoster involving the mandibular branch of the trigeminal nerve. Cytology revealed characteristic features of the infection including nuclear moulding, multinucleated giant cells and ballooning degeneration. Conclusion(s): More recently, patients presenting with herpes zoster have been reported to have sub-clinical Covid-19 infection, suggesting a possibility that herpes zoster might be an indicator for latent Covid-19. Timely detection and treatment of this infection can reduce the risk of post herpetic neuralgia.Copyright © 2022 Sciendo. All rights reserved.
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Myopia is a prevalent yet confusingocular disorder. Myopia,formerlyconsidered abenignrefractivecondition, is nowassociatedwithanincreasedriskofdevelopingseveraloculardisorders,evenatmodestlevels.Myopiaisaglobalproblemthatexpe rts have documented. Despite the fact that the specific cause of myopia remains a mystery, it appears to be a combinationof genetic and environmental factors, making the prevention and treatment of the condition difficult and highly personalised.Myopia can have a positive impact on both the quality of life and the health of the eyes if it is prevented. Progressive additionlenses (PAL), topical atropine, ortho-k (orthokeratology) lenses and multifocal contact lenses are some of the most commoncontrol options currently available. Myopia has gained prominence in optometry studies as a result of its high prevalence. It ismore common for children to suffer from problems, such as extreme myopia and myopic macular degeneration, if they begindevelopingmyopiaatanearlyage.Thepurposeofthisstudywillbetoconductaninquiryintotheepidemiologyandriskfactorsfor myopiainschool-agedchildren(aged 6-19years)aroundtheworld.Copyright © 2022, Anka Publishers. All rights reserved.
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The emergence of the Covid-19 pandemic had a major impact on education, resulting in an increase in the use of laptops. In order to minimize the acceleration of macular degeneration, it is necessary to develop technology to protect the surface of the screen, namely using the antioxidant aloe vera. It contains lutein and zeaxanthin. Aloe vera have anti-inflammatory effects and are found in the lens of the human eye. The purpose of this study was to prevent the occurrence of macular degeneration. The simple method used was conducted by aloe vera sonication following by mixing the aloe vera using TPU (thermoplastic polyurethane). All experiment was carried out through factorial design with two variables, i.e weight ratio of TPU and aloe vera and curing temperature. This research was statistically carried out by varying the weight ratio thermoplastic polyurethane/aloe vera (1-4) and temperature (30-40oC). The result showed the model was released significant in ANOVA assesment. Furthermore, testing the luxmeter as many as 13 screen protector variables then processed with a design expert application, obtained F-value data of 6.83 and P-value of 0.0127 (less than 0.0500). © 2023 Author(s).
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"Eyes are windows to the soul" - we can smell a rose but cannot see the immense beauty of it without eyes. Dramatic increase in asthenopic symptoms in the students and workers caused by electricity outage is common ocular problem in the rural areas of India. Moreover, Computer vision syndrome (CVS) has extended their deteriorative arms worldwide in post-COVID era due to increased screentime by extensive use of digital gadgets. Blue light released from digital gadgets causes macular degeneration through various factors including oxidative stress. Thus, there is a dire need of mitigative measures against CVS and electricity outage mediated asthenopic symptoms. The aim of the present study was to develop a preventive measure against asthenopia induced mental and ocular disorder. A spectacle frame having blue light blocking glasses along with strip of warm white LED was taken. The hollow temples of spectacles had a wire which was connected to LED strip on one end and another end was connected with neck band having rechargeable battery and intensity regulator feature. A prototype of advance eyewear was developed and patent was published (IPR Application no. 202211006479). Product of this prototype will be developed and commercialized through optical agencies (under discussion with Lenskart & Royal son). First 1 00 samples of the product will be distributed to the students of rural areas under community services. Therefore, it's most plausible applications may be Used as a preventive approach against asthenopia caused by electricity outage and CVS.Useful for the professionals working in dark areas (mechanic, Plumber, Electrician etc).
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Age-related macular degeneration (AMD) is the leading cause of blindness in developed countries. Intravitreal injections of antiangiogenic agents (anti-VEGF) can stop vision loss in the neovascular form of the disease (nAMD). The aim of this study was to assess the general health-related quality of life (HRQoL) in a cohort of patients with nAMD treated with intravitreal anti-VEGF injections and to detesrmine to what extent their HRQoL was affected by COVID-19. This was an observational, analytical, and longitudinal study performed with a two-wave panel survey. Clinical outcomes, HRQoL, and tangible support were evaluated. In the final survey, changes in living conditions and medical visits due to the COVID-19 pandemic were also examined. Of the 102 patients initially interviewed in the before-COVID survey, 24 were lost after 30 months of follow-up. In the initial assessment, the mean health index was 0.73 ± 0.2. The EQ VAS score worsened at the final survey (p = 0.048). Patients needing treatment in both eyes (p = 0.007) and with lower levels of bilateral visual acuity (p = 0.018) reported an increase in social support at the final survey. In conclusion, patients perceived a worsening in HRQoL after confinement. However, patients enjoyed good social support that improved in the after-COVID survey.
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Background: Healthcare services have been restricted after the coronavirus disease 2019 (COVID-19) outbreak. With the pandemic still ongoing, the patterns of orthopedic surgery might have changed. The purpose of this study was to determine whether the reduced volumes of orthopedic surgery were recovered over time. Among the trauma and elective surgery, which accounted for most orthopedic surgical procedures, we also sought to elucidate whether the changes in the volumes of orthopedic surgery differed according to the type of surgery. Methods: The volumes of orthopedic surgery were analyzed using the Health Insurance Review and Assessment Service of Korea databases. The surgical procedure codes were categorized depending on the characteristics of the procedures. The actual volumes of surgery were compared with the expected volumes to elucidate the effect of COVID-19 on surgical volumes. The expected volumes of surgery were estimated using Poisson regression models. Results: The reducing effect of COVID-19 on the volumes of orthopedic surgery weakened as COVID-19 continued. Although the total volumes of orthopedic surgery decreased by 8.5%-10.1% in the first wave, those recovered to a 2.2%-2.8% decrease from the expected volumes during the second and third waves. Among the trauma and elective surgery, open reduction and internal fixation and cruciate ligament reconstruction decreased as COVID-19 continued, while total knee arthroplasty recovered. However, the volumes of hemiarthroplasty of the hip did not decrease through the year. Conclusions: The number of orthopedic surgeries, which had decreased due to COVID-19, tended to recover over time, although the pandemic was still ongoing. However, the degree of resumption differed according to the characteristics of surgery. The findings of our study will be helpful to estimate the burden of orthopedic surgery in the era of persistent COVID-19.
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COVID-19 , Orthopedic Procedures , Orthopedics , Humans , COVID-19/epidemiology , Pandemics , Routinely Collected Health DataABSTRACT
Age-related macular degeneration is a leading cause of blindness in patients aged 50 years and older. Prior to the 21st century, there were no effective treatments for this devastating disease. However, the last 20 years have heralded the development of treatments for both the nonexudative and exudative forms. The invention of AREDS vitamin supplements and anti-VEGF therapies forever changed the treatment of dry and wet age-related macular degeneration, respectively. The rapid adoption and expansion of these vision preserving treatments has created controversy regarding their cost, burden of administration, development, and use of new technologies, genetic considerations, and observed societal disparities. Many of these controversies and disparities persist today and will require further research to resolve.