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.

Research progress of severe acute respiratory syndrome coronavirus 2 in ocular surface infection.

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), also known as COVID-19, is much more difficult to transmit through the ocular surface than that through the mouth and nose. However, the available evidence has suggested the possibility of ocular surface transmission, especially in medical staff. In this paper, we describe the existing SARS-CoV-2 ocular surface symptoms, the possible mechanism of SARS-COV-2 entering ocular surface cells and SARS-COV-2 transmission through ocular surface. In addition, the existing and future possible research directions of SARS-CoV-2 transmission through ocular surface were analyzed, so as to provide new ideas and methods for clinical treatment of SARS-CoV-2 from the perspective of ocular surface.Copyright © 2021, Xinxiang Medical University. All rights reserved.

Early infection risk in patients with systemic lupus erythematosus treated with rituximab or belimumab from the British Isles Lupus Assessment Group Biologics Register (BILAG-BR): a prospective longitudinal study

Background: Patients with systemic lupus erythematosus (SLE) are at an increased risk of infection relative to the general population. We aimed to describe the frequency and risk factors for serious infections in patients with moderate-to-severe SLE treated with rituximab, belimumab, and standard of care therapies in a large national observational cohort. Method(s): The British Isles Lupus Assessment Group Biologics Register (BILAG-BR) is a UK-based prospective register of patients with SLE. Patients were recruited by their treating physician as part of their scheduled care from 64 centres across the UK by use of a standardised case report form. Inclusion criteria for the BILAG-BR included age older than 5 years, ability to provide informed consent, a diagnosis of SLE, and starting a new biological therapy within the last 12 months or a new standard of care drug within the last month. The primary outcome for this study was the rate of serious infections within the first 12 months of therapy. Serious infections were defined as those requiring intravenous antibiotic treatment, hospital admission, or resulting in morbidity or death. Infection and mortality data were collected from study centres and further mortality data were collected from the UK Office for National Statistics. The relationship between serious infection and drug type was analysed using a multiple-failure Cox proportional hazards model. Finding(s): Between July 1, 2010, and Feb 23, 2021, 1383 individuals were recruited to the BILAG-BR. 335 patients were excluded from this analysis. The remaining 1048 participants contributed 1002.7 person-years of follow-up and included 746 (71%) participants on rituximab, 119 (11%) participants on belimumab, and 183 (17%) participants on standard of care. The median age of the cohort was 39 years (IQR 30-50), 942 (90%) of 1048 patients were women and 106 (10%) were men. Of the patients with available ethnicity data, 514 (56%) of 911 were White, 169 (19%) were Asian, 161 (18%) were Black, and 67 (7%) were of multiple-mixed or other ethnic backgrounds. 118 serious infections occurred in 76 individuals during the 12-month study period, which included 92 serious infections in 58 individuals on rituximab, eight serious infections in five individuals receiving belimumab, and 18 serious infections in 13 individuals on standard of care. The overall crude incidence rate of serious infection was 117.7 (95% CI 98.3-141.0) per 1000 person-years. Compared with standard of care, the serious infection risk was similar in the rituximab (adjusted hazard ratio [HR] 1.68 [0.60-4.68]) and belimumab groups (1.01 [0.21-4.80]). Across the whole cohort in multivariate analysis, serious infection risk was associated with prednisolone dose (>10 mg;2.38 [95%CI 1.47-3.84]), hypogammaglobulinaemia (<6 g/L;2.16 [1.38-3.37]), and multimorbidity (1.45 [1.17-1.80]). Additional concomitant immunosuppressive use appeared to be associated with a reduced risk (0.60 [0.41-0.90]). We found no significant safety signals regarding atypical infections. Six infection-related deaths occurred at a median of 121 days (IQR 60-151) days from cohort entry. Interpretation(s): In patients with moderate-to-severe SLE, rituximab, belimumab, and standard immunosuppressive therapy have similar serious infection risks. Key risk factors for serious infections included multimorbidity, hypogammaglobulinaemia, and increased glucocorticoid doses. When considering the risk of serious infection, we propose that immunosupppressives, rituximab, and belimumab should be prioritised as mainstay therapies to optimise SLE management and support proactive minimisation of glucocorticoid use. Funding(s): None.Copyright © 2023 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 license

A cross-sectional study to describe the spectrum of ocular manifestations and risk factors of mucormycosis presenting to a tertiary hospital of East India.

Purpose: To report the clinico-demographic profile of rhino-orbito-cerebral mucormycosis (ROCM) in patients during the "second wave" of the COVID-19 pandemic in eastern India, and their ophthalmic manifestations at presentation to our tertiary institute. Methods: Cross-sectional study amongst patients presenting to our center based on their hospital records. Demographic information, history related to COVID-19, records of detailed ocular examination, and microbiological, radiological, and histopathological investigation were entered into an online worksheet and analyzed using SPSS 26.0. Results: A total of 219 patients with ROCM were treated from May to September 2021, and 110 of these had ocular manifestations at presentation (50.2%). The age of patients ranged from 22 to 83 years and the mean ± standard deviation (SD) age was 49.9 ± 12.9 years. Ninety (81.8%) patients had been diagnosed with diabetes mellitus, 31 (34%) had hypertension, and 10 had other comorbidities. The duration between the onset of COVID-19 and mucormycosis symptoms was 0 to 60 days with a mean ± SD interval of 20.9 ± 12.6 days. Fifty-six (50.9%) patients had a history of steroid use. Unrelenting ocular or facial pain was the most common presenting symptom, ptosis was the most common anterior segment manifestation, and ophthalmic artery occlusion was the most common posterior segment manifestation. Conclusion: Our data from eastern India reinforces the relationship between COVID-19, diabetes, corticosteroid use, and ROCM. Knowledge of various presenting anterior and posterior segment manifestations of the disease as described in the present study will guide clinicians to recognize the disease early and make every effort to prevent complications.

Rates and predictors of serious infections in MS and NMOSD patients treated with anti-CD20 therapy

Introduction: Chronic immunosuppression with anti-CD20 therapy can increase the risk of serious infections including complicated COVID19. Objectives and Aims: To evaluate the rates and predictors of serious infections in MS and NMOSD patients treated with anti- CD20 agents. Method(s): MS and NMOSD patients treated with ocrelizumab or rituximab at University Hospitals Cleveland Medical Center were evaluated. Patients hospitalized for any infection during their anti- CD20 therapy were identified and compared to those without infection-related hospitalizations. Significant differences were evaluated in a multivariate logistic regression model to identify predictors of serious infection. Result(s): There were 184 patients treated with anti-CD20 therapy (average age 48+/-13 years, 67% females, 84% MS). Of those, 21 (11%) patients had one or more serious infection during therapy including 16 MS patients treated with ocrelizumab and 5 NMOSD patients treated with rituximab. The most common serious infections were complicated COVID19 (9), bacterial skin infections (5), bacterial pneumonia (3), urosepsis (3), ocular infection (1), and disseminated shingles (1). Compared to those without serious infections, patients with serious infections had a higher average time on anti-CD20 therapy (1087.57+/-5 days vs 796.28+/-35 t= -2.61, P=0.005) and were more likely to have total lymphopenia (80% vs 40%;P=.004). There was a trend towards higher rates of hypogammaglobulinemia in patients with serious infections (24% vs 10%;P=.07). Logistic regression identified total lymphopenia (<1.0 x109/L) as an independent predictor of serious infection in patients treated with anti-CD20 therapy. Conclusion(s): Serious infections are rare in MS and NMOSD patients treated with anti-CD20 therapies. Those with serious infections were exposed to treatment longer and more frequently had lymphopenia and hypogammaglobulinemia. Total lymphopenia during therapy is an independent risk factor for serious infections.

The expression of SARS-CoV 2 co-receptors and glia reaction in eyes of normal and COVID-19 diseased patients

Purpose : With this research project we wanted to approach the question of whether SARS-CoV 2 can infect the eye. In order to infect ocular tissues, virus-specific receptors;coreceptors or proteases must be present in the eye tissue. SARS-CoV 2 uses the human angiotensin converting enzyme 2 (ACE2) receptor to enter cells. In addition, the mammalian serine protease TMPRSS2, the protease furin and the glycoprotein neuropilin are identified as relevant proteases for the interaction of the virus with ACE2. Last year, we were able to show that ACE2 is significantly more expressed in ocular tissue of covid patients. Here the expression level of the co-receptor and glia markers, as well as the present of virus was confirmed in this study. Methods : Seven eyes from donors without covid disease (COVID-) as well as ten fixed eyes from COVID-19 patients (COVID+) were analysed for their expression profile of ACE2, TMPRSS2, neuropilin and furin in the retina and cornea. The ocular tissues were examined for protein expression by immunohistochemical staining or for RNA expression by quantitative real-time PCR. In addition, viral spike protein was detected histologically in eyes, and expression profiles of GFAP and Iba-1 were assessed. Results : Similar to ACE2 and TMPRSS2, the two proteases neuropilin and furin were detected in the retina and cornea. Interestingly, the expression profile differed in terms of strength and localization, especially in the retina. The presence of the virus in both cornea and retina was also demonstrated by the detection of viral spike protein. In all COVID+ retinas, strong GFAP staining was observed as well as some Iba-1 positive cells, suggesting activation of macro- and microglia. Conclusions : Expression of ACE2, TMPRSS2, furin and neuropilin was demonstrated in COVID+ ocular tissues. In addition to the virus detection in retina and cornea, a glial reaction could also be observed. One can therefore assume an infection of the eye in these cases. However, in summary it can be said that an infection of the eye tissue is possible since all demanded receptors are present.

Corneal innervation changes after Sars-Cov-2 Infection. An In vivo Confocal Microscopy Study

Purpose : To measure the innervation of the corneal subbasal nerve plexus of Covid-19 patients and compare the results with values of healthy patients. Methods : A prospective, observational study was conducted analyzing 39 eyes of patients who had overcome Covid -19 and 46 eyes of healthy volunteers included as a control group (verified by antibody analysis and negative qPCR result) which underwent in vivo confocal microscopy with Rodstock Cornea Module© attached to Heildelberg HRT3© . Ocular surgery procedures, previous ocular infections or systemic diseases that could cause alteration in corneal innervation were exclusion criteria. At least 5 non overlapping images of each eye were selected and only one eye of each patient was included in the study. Following sub basal nervous plexus parameters were measured with ACC Metrics © software: Corneal Nerve Fiber Density (CNFD), Corneal Nerve Branch Density (CNBD), Corneal Nerve Fiber Length (CNFL), Corneal Total Branch Density (CTBD), Corneal Nerve Fiber Area (CNFA), Corneal Nerve Fractal Dimension (CNFrD). Data analysis was performed with SPSS® software for Windows 22.0 (SPSS® Inc, Chicago, IL.). The differences of age and sex between groups were checked with T-test and chi-square tests. The normality of the sample was checked with the Shapiro-Wilk test and the results were compared with the T test or the Man-Whitney U test based on the distribution of the data. The differences were considered statistically significant for p<0.05. Results : There was no difference in the sex distribution between the groups (p= 0.248). The average age (± standard error) was 46.61±17.55 years for Covid-19 patients and 43.11±16.95 years for healthy control group (p=0.353) The mean of the analyzed variables (± standard error) from Covid-19 patients versus control group were CNFD: 16.09±6.92 and 23.03±8.31 fibers/mm2 (p=0,00008), CNBD: 21.93±15.37 and 28.93±17.84 branches/mm2 (p=0.064), CNFL: 11.61±3.61 and 14.05±3.71 mm/mm2 (p=0.002), CTBD: 38.48±20.02 and 43.29 ± 23.94 (p=0.41), CNFA: 0.0057±0.0017 and 0.006±0.0023 mm2 /mm2 (p=0.853), CNFrD: 1.46±0.041 and 1.47±0.037 (p=0.007). Conclusions : According to the data obtained, corneal subbasal nerve plexus is decreased in Covid-19 patients compared to the healthy control group, statistically significant for density, length, and fractal dimension. The results show the presence of possible small fiber neuropathy induced by Covid-19 disease.

Updates on Coronavirus-Related Ocular Manifestations: From the Past to COVID-19 Pandemic

Context: Coronaviruses are the largest RNA viruses associated with some ocular manifestations. There are various contradictory reports about the ocular manifestations of coronaviruses in humans. Different ocular tissues can affect coronavirus-associated infectious diseases. Evidence Acquisition: All manuscripts were collected from PubMed, Google Scholar, and other relevant databases. All searches were done by specific keywords, including "coronavirus," "ocular disease," and "eye." Results: There are various contradictory reports about the ocular effects of coronaviruses in humans. Different ocular tissues are involved in coronavirus-associated infectious diseases. The ductal connection between the upper respiratory tract and eye mucosa through the nasolacrimal duct can be an entrance to respiratory viruses, such as coronaviruses. The coronavirus can infect the retina, conjunctiva, cornea, and uvea of the eye. The primary SARS-CoV-2 receptor, ACE2, is mainly expressed in the posterior tissues of the eye, such as the retina and RPE. Feline CoV, SARS-CoV, MERS-CoV, and infectious bronchitis virus (IBV) are responsible for conjunctiva involvement in coronavirus-related ocular pathogenesis. Also, various studies are held on COVID-19 and the impact of the conjunctiva on diagnosis and medical complications. Given that the cornea has an acceptable expression of ACE2 and TMPRSS2 genes compared to lung tissue, some studies were done on the impact of the cornea in COVID-19. Feline infectious peritonitis virus (FIPV) is also related to uvea complications. The experiments of human and animal models on the effects of coronaviruses on the retina and cornea in the event of various epidemics of coronaviruses and new and unknown ocular complications can be of great help to future studies. Conclusions: Given the importance of investigating the pathogenesis and other routes of SARS-CoV-2 infection, especially in areas other than the respiratory tract, this report attempts to highlight the importance of eye infections caused by the virus, its role in maintaining the virus transmission chain, and its impact on public health.

PREVENTING MEASURE OF NOVEL APPROACH OF COVID 19 EYE PROTECTION AND SOCIAL DISTANCING: A SYSTEMATIC REVIEW

Public health and societal efforts can avoid the 2019 Corona pandemic (COVID-19). Ethiopia has adopted health and social measures. COVID-19 social distance and health prevention research. SARS-CoV-2 produces COVID-19. The global vaccine effort must understand how the virus spreads to end the pandemic. SARS-CoV-2 spreads by respiratory droplets and aerosols, according to new studies. Temperature, humidity, precipitation, air currents, pH, and radiation affect transmission. Hand washing and masks are also helpful public health measures. Non-pharmaceutical remedies need more research. Body-invading eye bacteria exist. There's no indication that COVID-19 exposure causes the disorder's ocular symptoms. Tears and conjunctiva contained SARS-CoV-2. Ocular symptoms may be the first or only sign of infection. Hand cleanliness, social isolation, and hospital SOPs can limit illness spread. Eye lubricants and spectacles can prevent eye infections.

Ocular Surface Infection by SARS-CoV-2 in COVID-19 Pneumonia Patients Admitted to Sub-Intensive Unit: Preliminary Results.

The aim of the present study is to check the relationship between virus detection on the conjunctival swabs by RT-PCR and the systemic and ocular clinical data, treatments, and to the modalities of administration of supplemental oxygen. The SARS-CoV-2 RNA reverse-transcriptase PCR assay of conjunctival brushing samples and the corneal/conjunctival clinical findings were evaluated in 18 eyes of 9 consecutive patients admitted to the COVID-19 Sub-intensive Unit of Salerno Hospital University, Italy. Conjunctival swabs were positive for SARS-CoV-2 in 13 eyes of 7 patients; corneal epithelial defects were detected in 9 eyes. The seven patients with ocular involvement from SARS-CoV-2 had undergone treatment with a full-face mask or oxygen helmet in the last week, while the two subjects with negative conjunctival swabs had been treated with high flow nasal cannula. The positivity to the conjunctival test for SARS-CoV-2 was higher (72%) than that reported in the literature (10-15%) and related in all cases to the use of facial respiratory devices. These results suggest that exposure of unprotected eyes to aerosols containing high concentrations of SARS-CoV-2 could cause a keratoconjunctival viral infection. Further studies are needed to verify the causal link with the use of respiratory facial devices in patients suffering from COVID-19 pneumonia.

Evidence-based of conjunctival COVID-19 positivity: An Italian experience: Gemelli Against COVID Group.

BACKGROUND: The possible transmission of severe acute respiratory coronavirus 2 (SARS-CoV-2) by tears and conjunctiva is still debated. METHODS: Main outcome was to investigate the agreement between nasopharyngeal swab (NPs) and conjunctival swabs (Cs) in patients with SARS-CoV-2 infection. We divided patients into four groups: (1) NPs and Cs both negative (C-NF-), (2) NPs positive and Cs negative (NFs+Cs-), (3) NPs negative and Cs positive (NFs-Cs+), and (4) NPs and Cs both positive (NFs-Cs+). The secondary outcomes were to correlate Cs results with systemic clinical parameters such as: oxygen saturation (SpO2), dyspnea degree (DP), radiologic pulmonary impairment based on chest radiography (XR) or computed tomography (CT), blood chemistry as D-Dimer (D-Dimer), fibrinogen, ferritin, lactate dehydrogenase (LDH), and C-reactive protein (C-RP). RESULTS: A total of 100 conjunctival swabs in 50 patients with SARS-CoV-2 have been enrolled in this interventional clinical trials. Ocular signs (conjunctivitis) were present in five patients (10%). NPs and Cs highlighted a poor level of agreement (0.025; p = 0.404). Median SpO2 levels are the highest in the NF-C- group (98%) and the lowest (90%) in the group NF+C+ (p = 0.001). Pulmonary impairment was statistically significantly different between NFs and Cs groups (p = 0.019). Pulmonary impairment score increased from NFs-Cs- group (3.8 ± 3.9), to NFs+Cs+ group (6.7 ± 4.1). Intensive care unit patients showed higher COVID-19 Cs positivity in conjunctiva (12.5%) against hospitalized ones (5.8%). CONCLUSIONS: In patients hospitalized for SARS-CoV-2 the virus can be detected in conjunctival swab. Intensive care unit patients may reveal a higher COVID-19 presence in the conjunctiva. The most severe pulmonary impairment can be observed in NFs and Cs positivity. TRIAL REGISTRATION: Clinicaltrials.gov registration. ETHICAL COMMITTEE AUTHORIZATION: ID number: 0013008/20.

Smart polymeric eye gear: A possible preventive measure against ocular transmission of COVID-19.

The angiotensin-converting enzyme 2(ACE-2) receptors with approx. 0.8% congestion in conjunctival surface, leads to increase susceptibility of Covid-19 transmission through ocular surface. It has been observed that prophylactic measures such as goggle or face shield are unable to offer complete protection against ocular transmission of SRS-CoV-2. Hence, it is hypothesized that topical ocular prophylaxis using biocompatible polymers with reported in-vitro and in-vivo evidence of ACE inhibition and antiviral activity appears to be a promising strategy for preventing ocular transmission of Covid-19 to healthcare workers. They are capable of binding to ACE-2 receptors which may provide highly potential trails to block virus entry to host cells. Further biopolymers imparting antiviral activities greatly improve their protective performance. They not only provide prolong protection but also are safe for long-term use. This article discusses the description of structural and functional attributes of ACE-2 to identify appropriate polymer with better binding affinity. Furthermore, potential polymers with appropriate concentration are suggested for evaluation through a hypothesis to consider them for Covid-19 implication.