Challenges in the management of retinoblastoma during nationwide lockdown: an observational study from a retinoblastoma center in South India

Introduction: The nationwide lockdown due to coronavirus disease 2019 led to travel restrictions resulting in a delay in diagnosis, treatment, and follow-up of children with retinoblastoma (RB). Objectives: We audited the impact and challenges of lockdown among RB children over 1-year period (May 2020-2021). Materials and Methods: It is a cross-sectional study of 104 children with RB, who presented within the 1-year study period. The demographic details, clinical presentations, and outcome of treatment due to lockdown were studied. Results: Of the 152 eyes of 104 children, unilateral RB was observed in 52% and bilateral in 48%, in which four children had metastatic disease and one child had trilateral RB. International classification groups D (n: = 64 eyes, 42%) and E (n: = 38 eyes, 25%) were in majority. Almost, half of the children (n: = 53, 51%) underwent enucleation. Overall, the vision was preserved in 32% of the children and globe preservation in 49% of children. Eleven children (10.5%) succumbed due to disease progression. But, only five children were affected with severe acute respiratory syndrome coronavirus 2 infection. The majority of children (n: = 72, 69%) had to travel more than or equal to 1,000 km for treatment. About 57% (n: = 60) patients were newly diagnosed during the lockdown period and due to the travel restrictions, they had a mean delay of 2.2 months (range: 0-15 months) in starting treatment and 27% (n: = 29) of children on treatment had an interruption of treatment. Conclusion: Multidisciplinary team management with strategies to support the RB families during locked down crisis is essential to continue care without interruptions.

Endogenous panophthalmitis in a patient with COVID-19 during hospitalization in an intensive care unit: A case report.

Purpose: To report a case of endogenous panophthalmitis in a patient with COVID-19 during treatment in an Intensive Care Unit. Observation: A 64-year-old woman with COVID-19 and Salmonella septicemia presented with decreased visual acuity, ocular pain, and proptosis in her right eye after treatment with favipiravir, intravenous dexamethasone, and ceftriaxone. An ocular examination of her right eye revealed periorbital tenderness, exophthalmos, and corneal haze. The ultrasonography showed a subretinal abscess. Her right eye lost light perception vision and underwent enucleation. Microbiologic evaluation of the enucleated right eye was negative for organisms. Conclusions and importance: Patents with COVID-19 may develop severe ocular involvement after COVID-19 due to a generalized reduction in immunity. Comorbidities and intensive care unit treatments can predispose COVID-19 patients to endogenous panophthalmitis.

Varied presentations of pancreatic insulinoma: a case report.

An insulinoma is a rare functional pancreatic neuroendocrine tumour that is usually sporadic and solitary. The hallmark is hypersecretion of insulin, which leads to neuroglycopenia symptoms and uncontrolled sympathoadrenal activity. Neuroendocrine tumours can have a varied presentation, with symptoms often ascribed to a different diagnosis, thus delaying correct diagnosis and treatment. We present the case of a 26-year-old female who had a 3-year delay before diagnosing insulinoma after being initially assessed with epilepsy and schizophrenia. The case report below provides a detailed review of the diagnosis, tumour localization, and surgical interventions implemented for the patient during the COVID-19 pandemic.

The Future of Red Cell Transfusion Lies in Cultured Red Cells

Blood is a very important resource for healthcare-based services and there has been a consistently increasing demand for it in most parts of the world. Poor volunteer-based collection system, high-risk of transfusion-transmitted infections, and emergence of new pathogens as evident from the ongoing Coronavirus Disease 2019 (COVID-19) pandemic are potential challenges to the global healthcare systems. It is imperative to explore safe and reliable alternatives to red cell transfusions. Ex vivo culture of red cells (cRBCs) from different sources such as hematopoietic stem cells (HSCs), pluripotent stem cells, and immortalized progenitors (e.g., BELA-2 cells) could revolutionize transfusion medicine. cRBC could be of great diagnostic and therapeutic utility. It may provide a backup in times of acute shortages in patients with rare blood groups, and in cases with multiple antibodies or sickle cell anemia. The CRISP-Cas9 system has been used to develop personalized, multi-compatible RBCs for diagnostic reagents and patients with multiple allo-antibodies. cRBC could be practically feasible for pediatric patients, who require small quantities of red cell transfusions. cRBC produced under good manufacturing practice (GMP) conditions has been reported to survive in human blood circulation for more than 26 days. Recently, a phase I randomized controlled clinical trial called RESTORE was initiated to assess the survival and recovery of cRBCs. However, feasible technological advancement is required to produce enough cRBCs for clinical use. It is crucial to identify sustainable sources for large-scale production of clinically useful cRBCs. Although the potential cost of one unit of cRBC is extrapolated to be around US$ 8000, it is a life-saving product for patients having rare blood groups and is a "ready to use" source of phenotype-matched, homogenous young red cells in emergency situations.