Evaluation of Microbiological Culture and Antibiogram of the Patient with Corneal Ulcer due to Exposure Keratitis in the Intensive Care Unit in Sina Farshchian Hospital (2019-2020)

Background: Since patients admitted to the intensive care unit have a compromised im-mune system and are more prone to infection than other patients, timely diagnosis and treatment of corneal ulcers among this group of patients can prevent vision loss. Therefore, it is necessary to treat eye infections and corneal ulcers promptly and economize prohibitive costs. Objective(s): Appropriate treatment with the most effective antibiotic before the answer is available to prevent corneal ulcer complications and blindness. Method(s): This study was conducted from November 2019 to November 2020 and after approval by the ethics committee of Hamedan University of Medical Sciences with the code of ethics: IR.UMSHA.REC.1398.716. First, the corneal secretions of 121 patients admitted to the intensive care unit of Sina Hospital are prepared by an ophthalmologist (after anesthetizing the cornea with tetra-caine drops and sterile swabs) and culture in four growth mediums (blood agar, chocolate agar, thio-glycolate, and EMB). Microbial cultures are examined after 48 hours and a fungal culture is examined one week later. Disc diffusions are placed in positive microbial cultures. Antibiotic susceptibility or resistance of the antibiogram was recorded. Other demographic data, including patients' age and sex, are extracted from ICU files. Also, test results and patient identifications are recorded in a checklist designed for this purpose. Result(s): Of all the antibiotics used against common bacteria, vancomycin (84%), colistin (80.43%), cefazolin (80%), and levofloxacin (60%) had the highest sensitivity and gentamicin (93.75%), ceftazidime (86.42%) Erythromycin (85%) had the highest resistance against isolated bacteria. Conclusion(s): The data obtained from this study showed that the most common microorganisms in the age group under the age of 30 years were Acinetobacter Baumannii, in the group of 30-60 years old was Klebsiella pneumonia, and age group over 61 years old was Staphylococcus aureus, and the most sensitive antibiotics in the age group under 30 years were vancomycin and levofloxacin and the age group30-60 were colistin and vancomycin and in the age group over 61 years were vancomycin and cefazolin.Copyright © 2023 Bentham Science Publishers.

Risk factors affecting outcome of rhino-orbital-cerebral mucormycosis in COVID-19 patients

Background: Mucormycosis is a serious life-threatening fungal infection that recently made severe sudden and devastating surge during the second wave of the COVID-19 epidemic with a mortality rate of up to 50%. Although the causality link between COVID-19 and rhino-orbito-cerebral mucormycosis (ROCM) remains unclear, many factors including poor diabetes control, high doses of steroids, viral-induced lymphopenia, and cytokine storm have been attributed to ROCM in patients with COVID-19. Orienting to risk factors and early recognition of this potentially fatal opportunistic infection is the key to optimal management and improved outcomes. In these contexts, we conducted a prospective study for 33 patients admitted to our tertiary hospital to determine the risk factors for ROCM in patients with COVID-19 and the cumulative mortality rates. Result(s): This study found a statistically significant relation between the fate of death in COVID-MUCOR patients who had presented fever, ophthalmoplegia, facial skin necrosis, and visual loss with those who received dose of steroid to control their respiratory symptoms P < 0.001. Death from COVID-MUCOR was statistically significant related to the prolonged interval from the onset of the symptoms to start of treatment and intervention. Also, it was found that there was a significant decrease in duration between COVID-19 infection and the start of mucormycosis (days) with incidence of DKA on admission. Nineteen (57.6%) of the patients had uncontrolled diabetes mellitus (hemoglobin A1C (HbA1c) of > 7.0%). Conclusion(s): Mucormycosis epidemic was precipitated by a unique confluence of risk factors: diabetes mellitus, widespread use of steroids, and perhaps SARS-CoV-2 infection itself. Restricting steroid use in patients with severe COVID-19 requiring oxygen therapy, and screening for and optimally controlling hyperglycemia, can prevent COVID-MUCOR in a large majority.Copyright © 2023, The Author(s).

‘Did COVID-19 exist before the scientists?' Towards curriculum theory now

We live in an era that normalized absurdism and abnormality. From successive devastating economic and environmental havoc, the world is now before a pandemic with a lethal footprint throughout the planet. The pandemonium became global. This paper situates the current COVID-19 pandemic within the context of an endless multi-plethora of devastating sagas pushing humanity into an unimaginable great regression. In doing so, the paper examines, how such pandemic reflects the very colors of an intentional epistemological blindness that frames Eurocentric reasoning, which crippled the political economy of global capitalism deepening and accelerating a never-ending and non-stop crisis that started in 2008. The paper explores also the social construction of the current pandemic and argues for alternatives ways to think and to do education and curriculum theory alternatively to challenge Modern Western Eurocentric reasoning. In doing so, advances itinerant curriculum theory as a just approach, a just alter-curriculum ‘theory now', one that respects the world's pluri-epistemological diversity, and aims to walk way from utopias framed within the borders determined by coloniality towards an anti-decolonial climax, and ‘heretopia'.

Vitamin A Deficiency, COVID-19, and Rhino-Orbital Mucormycosis (Black Fungus): An Analytical Perspective.

Mucormycosis is a rare but serious opportunistic fungal disease characterized by rhino-orbito-cerebral and pulmonary involvement. It is mainly seen in people with secondary immunosuppression, isolated vitamin A deficiency, measles, and AIDS patients. It showed a rise during the second wave of the COVID-19 epidemic in the spring of 2021 in India, especially in diabetic COVID-19 patients. Vitamin A deficiency is known to cause nutritional immunodeficiency and hence leading the way to increased opportunistic fungal, bacterial, and viral infections. In the eye, it causes keratitis, night blindness, xerophthalmia, conjunctivitis, Bitot spots, keratomalacia, and retinopathy. It also causes decreased tear secretion and deterioration of the anatomical/physiological defense barrier of the eye. The negative impact of vitamin A deficiency has been previously demonstrated in measles, AIDS, and COVID-19. We think that mucormycosis in COVID-19 might be rendered by vitamin A deficiency and that vitamin A supplementation may have preventive and therapeutic values against mucormycosis and other ocular symptoms associated with COVID-19. However, any vitamin A treatment regimen needs to be based on laboratory and clinical data and supervised by medical professionals.

Loss of Vision Outcome for Allergic Fungal Sinusitis: Case Report and Literature Review.

Visual loss is a rare manifestation of allergic fungal rhinosinusitis (AFRS). We report a case of an adult male who was diagnosed with AFRS and who presented during the COVID-19 pandemic lockdown with sudden-onset complete vision loss and a lack of recovery after surgical and medical management. We reviewed the literature on reported cases of AFRS complicated by visual loss to identify factors associated with visual outcomes. We found 50 patients who were diagnosed with acute visual loss due to AFRS, with an average age of 28 ± 14 years. Complete and partial recovery after surgical intervention were reported in 17 and 10 cases, respectively. However, the absence of vision improvement was reported in 14 of the cases. Early diagnosis and prompt intervention can return vision back to normal. However, delayed presentation, complete loss of vision, and acute onset of visual loss are associated with worse outcomes.

Taking Class Seriously

This article critically analyzes the human rights perspective upon what has emerged as one of the most significant socioeconomic and political challenges confronting many millions of people residing within high-income, liberal-democratic societies: rising poverty and socioeconomic inequality. This article argues that international and domestic human rights law and the social and political imaginaries of the wider human rights community largely fail to adequately diagnose and effectively respond to poverty and inequality within high-income, liberal-democratic societies. As a political and ethical doctrine founded upon a normative commitment to social justice, human rights should be taking the lead in efforts to condemn, understand, and develop responses to the poverty and inequality which blight the lives of many millions of people within many of the world's most affluent and, allegedly, most "liberal” societies. Human rights law has historically not done so. We, as a community, have not done so. This article offers a specific explanation for this continuing failure, by focusing upon the absence of any concerted recognition of or engagement with social class as it contributes to and compounds our exposure to poverty and inequality. Human rights remain largely blind to the many ways in which social class is intricately connected to poverty and inequality. The human rights community within high-income, liberal-democratic societies characteristically fails to take class seriously. Building upon previous writing in this area, this article explains why class is rarely recognized or engaged with by the human rights community. This article also sets out the basis for how we might begin the task of overcoming this highly damaging class blindness, to set the stage for what the author asserts as an urgent need if human rights is to provide the kind of political and ethical leadership required to effectively engage with poverty and inequality in affluent societies: the degentrification of human rights.

Time course study of optical coherence tomography angiography in patients with methanol induced optic neuropathy.

INTRODUCTION: In countries where alcoholic beverages are legally prohibited, methanol toxicity usually occurs due to ingesting homemade alcoholic drinks. The initial ophthalmologic symptoms of methanol toxicity typically appear 6-48 h after ingestion, and the severity of symptoms varies widely from mild and painless decreased vision to no-light perception vision. METHODS: This prospective study examines 20 patients with acute methanol poisoning within 10 days of use. Patients underwent ocular examinations, BCVA (Best Corrected Visual Acuity) recording, and OCTA (Optical Coherence Tomography Angiography) of the macula and optic disc. BCVA measurement and imaging were repeated one month and three months after intoxication. RESULTS: There was a statistically significant reduction in superficial parafoveal vascular density (P-value = 0.026), inner retinal thickness (P-value = 0.022), RNFL (Retinal Nerve Fiber Layer) thickness (P-value = 0.031), and an increase in cup to disc ratio (P-value < 0.001), and central visual acuity (P-value = 0.002) in this time course. However, there was no statistically significant difference in FAZ (Foveal Avascular Zone) area (P-value = 0.309), FAZ perimeter (P-value = 0.504), FD-300 (Foveal density, vascular density within a 300 µm wide region of the FAZ) (P-value = 0.541), superficial vascular density (P-value = 0.187), deep foveal vascular density (P-value = 0.889), deep parafoveal vascular density (P-value = 0.830), choroidal flow area (P-value = 0.464), total retinal thickness (P-value = 0.597), outer retinal thickness (P-value = 0.067), optic disc whole image vascular density (P-value = 0.146), vascular density inside the disc (P-value = 0.864), or peripapillary vascular density (P-value = 0.680) at different times. CONCLUSION: Over time, methanol poisoning can cause changes in retinal layers thickness, vasculature, and optic nerve head. The most important changes include cupping of the optic nerve head, reduction in RNFL thickness, and inner retinal thickness.

Management of Allergic Fungal Rhinosinusitis Associated with Vision Loss During COVID-19 Era.

The ongoing COVID-19 pandemic has given rise to unique challenges related to healthcare management. The problems have arisen due to the direct effect of COVID 19 infection and treatment or as repercussions of administrative efforts being undertaken to check the rapid spread of the epidemic. The management of some of the diseases has been hampered with the implementation of the policies like lockdown and transportation difficulties. This paper presents a series of four patients (6 eyes with vision loss) of an otherwise benign entity, Allergic Fungal Rhinosinusitis (AFRS), causing visual deterioration, managed amid the pandemic. AFRS has been known to cause vision loss by pressure over the optic nerve or its blood supply; however, a timely surgical intervention in the form of functional endoscopic sinus surgery to remove the disease and decompress the optic nerve, results in favourable outcomes in most patients. A delay in diagnosis and treatment may result in irreparable damage with the resulting inability to salvage the vision. In our series, we observed that vision recovery could be achieved in 66.7% of the affected eyes (four out of six eyes), while a poor visual outcome was observed in two (33%). The poor visual outcome was observed for the eyes with a prolonged visual impairment (4-6 months) at the time of presentation. We would appeal to the physicians to be cognizant of the adverse outcomes associated with the delayed surgical intervention of AFRS in the current pandemic scenario.

Teleophthalmology : A Case of Eye Care Delivery

As a result of COVID-19, a new approach for delivering eye care services to rural underprivileged areas were needed to improve eye disease outcomes. Sitapur Eye Hospital used a door-to-door model of medical delivery to alleviate the inability of rural residents from not receiving appropriate eye care during the COVID-19 pandemic. Sitapur Eye Hospital utilizes a healthcare delivery model that involves visiting patients door-to-door. The total number of patients that Sitapur Eye Hospital examined went from screening no patients in the months of April and May to screening 31,017 patients via the door-to-door service that was implemented in June 2020. Sitapur Eye Hospital managed to keep the prevalence of people who had severe eye impairment at pre-pandemic levels by offering a door-to-door service to patients who were unable to access appropriate medical care. The door-to-door healthcare model shows that leveraging telehealth and ride-hailing services alleviate certain barriers that make it difficult for people in rural areas to access eye care.

New-onset neuromyelitis optica spectrum disorder in a patient with COVID-19 and chronic Hepatitis B co-infection

Background: Neurological autoimmune disorders are often triggered by bacterial and viral infections, with growing evidence supporting coronavirus disease 2019 (COVID-19) infection precipitation of these disorders. COVID-19 is already implicated in causing discrete para-infectious neurological syndromes: acute disseminated encephalomyelitis (ADEM), transverse myelitis, neuromyelitis optica spectrum disorders (NMOSD), Guillain-Barre syndrome (GBS), and is also associated with encephalopathy, acute cerebrovascular disease, neuromuscular disorders, and seizures. Case Presentation: We describe a case of a 43-year-old Asian woman with chronic Hepatitis B (HBV) co-infected acutely with COVID-19, presenting with urinary retention, bilateral blindness, thoracic sensory level, and quadriparesis. Extensive workup narrowed down her diagnosis as seronegative NMOSD. She had complete resolution of symptoms after treatment with concurrent plasma exchange (PLEX), high dose corticosteroids, and emtricitabine-tenofovir. Follow-up visit showed no seroconversion at 6 months and no relapses. Conclusion(s): Our literature review highlights the likely link between COVID-19 infection and the development of neurologic autoimmune diseases. Our literature review supports a virus-triggered immune-mediated process rather than neuro-invasion. Many viral illnesses have been linked to the development of NMOSD and anti-AQP4 antibody-related myelitis. Additionally, there is limited literature linking chronic HBV infection with the development of optic neuritis and speculation thatcross-reactivity between HBsAg and myelin antigens may lead to the development of demyelinating diseases in the CNS and PNS. We observed remarkable clinical improvement after treatment with alternating days of IV methylprednisolone and therapeutic PLEX.Copyright © 2022

CoVid-19 and Influenza co-infection within North-West England: Flu-Rona - we won't ever find it if we don't look for it

Introduction: During the 2021/22 influenza season, media outlets reported on potential influenza A/B and CoVid-19 coinfection, termed 'flu-rona'. National guidelines (Management of CAP in Adults, BTS, 2009) suggest patients admitted with respiratory infection should undergo respiratory viral PCR (rvPCR) swabbing, severity dependent. We assessed: (1) UK teaching hospital seasonal rvPCR swab data for flu-rona (2) rvPCR swabbing behaviour in respiratory inpatients. Method(s): (1) Collect data on all rvPCR swabs [Panther Analyser] from 1/12/21 for 6 weeks with indication & CoVid swab result within 7 days of rvPCR. (2) Assess rvPCR swabbing in respiratory ward admissions from 1/1/22 for 4 weeks. Result(s): (1) 234 patients underwent rvPCR testing, with none positive for influenza A/B. n=23 were positive for any virus. Haematology-oncology swabbed 136 patients (as per protocol). Of the remainder (n=98), 22.4% (n=22) had respiratory symptoms (RSx) - with one positive rvPCR swab. 10/98 were CoVid positive on concurrent testing, of whom 7 had RSx. (2) 117 patients were admitted to the respiratory ward, of whom 73 had RSx;of these n=53 CoVid positive with only 1 (2%) undergoing rvPCR swab, and 20 CoVid negative with only 2 (10%) undergoing rvPCR swabs (see table) Conclusion(s): We found no flu-rona and low rates of rvPCR swabbing in those with RSx despite national guidelines. While these data suggest rates of flu-rona are likely low, they highlight dangers of diagnostic blindness in the age of CoVid-19 and possible nihilistic beliefs regarding rvPCR testing in general.

When Bad News Becomes Routine: Slowly-Developing Problems Moderate Government Responsiveness

Established theories of the policy process recognize the challenges governments face in processing information. We examine how the ways in which public problems develop over time condition subsequent policy actions. We contend that policymakers will become routinized to and consequently under-respond to the accumulating signals of slowly-developing problems (i.e., those featuring long runs of relatively small changes). Event history analyses leverage variation across the United States in the development of the COVID-19 pandemic and the subsequent implementation of social distancing policies. Looking across the 50 states and Washington DC, we find that regions that saw protracted deterioration in their health situation were slower to respond with social distancing than those that saw an abrupt deterioration to the same point. These results highlight the risks associated with problems that worsen only gradually over time.

Color-blind racial attitudes in nursing students and faculty

Racial color-blindness is a meritocratic ahistorical false belief surrounding the denial, minimization, and distortion of the existence of racism that has detrimental effects on health. Critical race theory effectively centered race for this analysis. Faculty of all races except African American/Black had higher racial color-blindness than students on all 3 of the following sub-concepts of the Color-Blind Racial Attitudes Scale: Unawareness of Racial Privilege, Institutional Discrimination, and Blatant Racial Issues. These are all disadvantages to student success and show that nursing faculty may not be optimally poised to speak on the social determinants of health. Findings also showed that Latina/o/Hispanic students and students of "All Other Races" were less aware of racial privilege than White and Black/African American students. Students with lower GPAs were less aware of racial privilege and those with higher GPAs were more racially color-blind on the sub-concept of Institutional Discrimination. The sample for this study, comprised of nursing students and nursing faculty in a selection of California Community Colleges across Southern California was much more diverse than those in other similar studies where the sample was comprised predominantly of White people. A cross sectional within-subjects descriptive research design was used. Participants completed the Color-Blind Racial Attitudes Scale. While the Everyday Discrimination Scale was completed to control for experiences of discrimination in their level of racial color-blindness, it did not show a statistically significant relationship. Of the faculty in the sample, 52% were non White compared to the national average of 15.9% non-White for nursing faculty. The findings related to first language and language spoken at home are a strong indicator of the high diversity of the sample. English was the first language for 58% of the students and 86% of the faculty. English was the language spoken at home for 73% of the students and 91% of the faculty, while 67% of students and 65% of faculty were born in the United States. The year 2020 had unique historical events surrounding the dual pandemic of COVID-19 and racism. The heightened sensitivity to racism and police brutality as a result of the murder of George Floyd surely had some influence on the data collected for this study. The results support interventions related to raising awareness about color-blind racial attitudes. (PsycInfo Database Record (c) 2022 APA, all rights reserved)

Transient optic neuritis and perineuritis associated with anti-MOG antibody after SARS-CoV-2 mRNA vaccination

Backgrounds: To report the first case of left optic neuritis and perineuritis associated with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) BNT162b2 mRNA vaccination. Case presentation: A 39-year-old woman was referred and admitted to our hospital due to transient left visual field abnormality with left ophthalmalgia and headache 12 days after the first vaccination dose of SARS-CoV-2 (BNT162b2). On admission (Day 2), she presented with left ophthalmalgia and headache without any other neurological deficits including the movement of eyeballs, visual field, visual acuity, or nystagmus. MRI on Day 2 suggested slight left optic neural swelling;Gadolinium-enhanced MRI on Day 4 revealed left optic perineuritis. Test for serum anti-aquaporin 4 antibody was negative, whereas anti-myelin oligodendrocyte glycoprotein (MOG) antibody was positive. She was diagnosed with left optic perineuritis after SARS-CoV-2 mRNA vaccination. Her visual disturbance never recurred and her ophthalmalgia and headache subsided only with anti-inflammatory agents. Discussion(s): Many cases of optic neuritis associated with vaccinations have been reported except for SARS-CoV-2 BNT162b2 mRNA. To our knowledge, only one neuromyelitis optica case was associated with anti-MOG antibody. Therefore, we propose that SARS-CoV-2 mRNA vaccination may induce transient optic neuritis and perineuritis, associated with anti-MOG antibody in the present case. Conclusion(s): This is the first case of left optic neuritis and perineuritis associated with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) BNT162b2 mRNA vaccination.Copyright © 2022

"I Am Your Partner, Am I Not?” An inquiry into stakeholder inclusion in platform organizations in times of crisis

In this paper we contribute to the understanding of how failed stakeholder inclusion in times of crisis can lead to distrust of platform organizations. Drawing on the revelatory case of Airbnb, we explore how stakeholder inclusion was practiced when the platform was confronted with the COVID-19 pandemic, a severe context in which its business practices were disrupted and social interactions uprooted. Our qualitative analysis suggests that platform leaders failed to notice a dissonance between articulated stakeholder meaning and understanding (i.e., what they said) and the crisis response practices implemented (i.e., what they did and did not do). This ultimately fostered distrust and selective disengagement as stakeholders re-interpreted Airbnb's claims about their role and how stakeholders were given voice in times of crisis. Drawing on research in psychology, we utilize the concept of inattentional blindness as a novel metaphorical explanation for failed stakeholder inclusion in platform organizations in times of crisis. © 2023 The Author(s)

Using Technology to Enhance Special Education. Advances in Special Education. Volume 37

"Using Technology to Enhance Special Education," Volume 37 of Advances in Special Education, is a logically, thoughtfully organized, and well-sequenced text. It focuses on how general and special educators can use technology to work with children and youth with disabilities. This cutting-edge book involves researchers, scholars, educators, and leaders who are knowledge producers in the field. It is written to respond to today's changing world where technology has become a very powerful force. As it stands, the world is getting smaller and smaller;and what is happening in a location quickly becomes known everywhere. For example, during the tense periods of the global COVID pandemic, technology became the livewire of our world. This book begins with an introduction to technology and students with disabilities;and the remaining chapters focus on the role of technology in the education of students with learning disabilities, emotional and/or behavioral disorders, and intellectual disabilities, autism spectrum disorders, physical and health impairments, hearing impairments/deafness, visual impairments, and traumatic brain injuries. In addition, some chapters focus on the role of technology in achieving equitable and inclusive education, building culturally and linguistically responsive general and special education, and creatively using digital comics to improve written narratives. In the end, this book concludes with a chapter that forward looking ways to infuse technology in special education. We feel that this volume is an excellent resource for special education researchers, scholars, practitioners, and professionals who teach and serve students with disabilities.

Elimination of human onchocerciasis: progress report, 2021

This progress report provides an update on the progress made towards eliminating nnchocerciasis (river blindness) by the World Health Organization (WHO) as part of its road map on neglected tropical diseases for 2021-2030. The report highlights that the goal is to eliminate the need for mass drug administration of ivermectin in at least one focus in 34 countries by 2030, in more than 50% of the population in at least 16 countries and in the entire endemic population in at least 12 countries. However, challenges remain in achieving these goals, including incomplete mapping of all transmission zones, co-endemicity of onchocerciasis and loiasis, a potential decrease in sensitivity to ivermectin, uncoordinated cross-border work, suboptimal programme implementation and inadequate technical and financial resources. COVID-19 has also delayed national programmes, with millions of doses of preventive chemotherapy that should have been distributed expiring. The report also provides regional highlights, including that in 2021, 23 countries reported having treated a total of 142.3 million people for onchocerciasis, representing 58.1% of global coverage, and that the African region faces the greatest challenge with 99% of the global burden of the disease in this region.

COVID Blindness: Delayed Diagnosis of Aseptic Meningitis in the COVID-19 Era.

Diagnostic errors are a serious problem in healthcare. The diagnostic process is highly susceptible to cognitive bias and the current COVID-19 pandemic may cause normally accurate healthcare workers to make incorrect decisions. We report a case of aseptic meningitis that required five healthcare visits before it was correctly diagnosed. This case highlights the risk of anchoring bias and the importance of carefully assessing diagnostic processes during the COVID-19 pandemic. LEARNING POINTS: COVID-19 can disrupt the healthcare system and clinical environment and affect diagnosis due to anchoring bias.Healthcare providers should carefully check the COVID-19 illness script to reduce diagnostic errors.Healthcare providers should prepare and practice a diagnostic debiasing strategy during the COVID-19 pandemic.