Teleconsultation in primary ophthalmic emergencies during the COVID-19 lockdown in Paris: Experience with 500 patients in March and April 2020.

This prospective observational cohort study is based on the first 500 patients who requested emergency teleconsultation during the initial days of the COVID-19 lockdown in Paris, France between 20 March and 10 April 2020. It is the first study to assess the utility of emergency teleophthalmology with a simple smartphone application or web browser and a webcam to manage emergency eye care in a population with sudden restricted access to ophthalmologists. In this study, every patient who asked for an ophthalmic emergency consultation in a single specialized center in Paris ('SOS Œil') first had to undergo a teleconsultation appointment to evaluate the indication for a physical consultation to preserve lockdown. Under medical advice only, a physical appointment was given within a day (if necessary). The aim of the study was to describe the population and diagnoses and evaluate the main judgment criteria, defined as the 'ability of teleconsultation to properly indicate a physical consultation for fair diagnosis and treatment in eye emergencies'. This organization has permitted physicians and patients to preserve social distancing while avoiding 3 or 4 physical consultations per person. Notably, 27% of teleconsultations were followed by a physical appointment. There was a mean 4.12-day delay between symptom apparition and consultation, and less than 1 day for traumas, superficial corneal foreign body and neuro-ophthalmological emergencies. There was a 96% sensitivity and 95% specificity to properly evaluate the indication of a physical consultation and only 1.0% misdiagnoses that lead to delayed care. Hence, teleconsultation maintained satisfactory healthcare access to patients with severe ophthalmological disorders while preserving social distancing and sanitary precautions. Therefore, teleconsultation may be seriously considered as a way to efficiently regulate ophthalmic emergencies, especially for patients with limited access to a specialist.

Biodegradable poly(ether-ester) multiblock copolymers for controlled release applications.

Multiblock poly(ether-ester)s based on poly(ethylene glycol), butylene terephthalate, and butylene succinate units were synthesized by a two-step melt polycondensation reaction, with the aim of developing a new series of degradable polymers for controlled release applications. The copolymers were characterized with respect to their composition (NMR), thermal properties (DSC), and swelling. The main focus was on the degradation kinetics and release properties of the copolymers. The crystallinity and swelling could be tailored by the PEG segment length and the ratio of the building units. With increasing mol fraction succinate in the hard segment, the swelling increased. The in vitro degradation was found to occur by molecular weight decrease and mass loss. Substitution of the aromatic terephthalate units by aliphatic succinate units increased the degradation rate of the copolymers. Polymers with PEG segments of 1000 kg/mol showed a more pronounced degradation than copolymers containing shorter and longer PEG segments. Model proteins were successfully incorporated and released from the poly(ether-ester) films. Depending on the size of the protein, the release mechanism was based on diffusion of the protein and degradation of the matrix.

Biocompatibility and degradation of poly(ether-ester) microspheres: in vitro and in vivo evaluation.

Microspheres of a hydrophobic and a hydrophilic poly(ether-ester) copolymer were evaluated for their in vitro and in vivo biocompatibility and degradation. The microspheres prior to and after sterilization were tested for in vitro cytotoxicity. The in vivo biocompatibility of the poly(ethylene glycol) terephthalate and poly(butylene terephthalate) (PEGT/PBT) microspheres was evaluated subcutaneously and intramuscularly for 24 weeks in rabbits. The in vivo degradation of the microspheres was studied microscopically and compared to the in vitro degradation. The in vitro and in vivo studies showed the biocompatibility of the microspheres of both the hydrophobic and the hydrophilic PEGT/PBT copolymer. Extracts of these microspheres showed no cytotoxic reactivity in the in vitro cytotoxicity test. Sterilization of the microspheres by gamma irradiation did not affect the cytotoxicity. PEGT/PBT microspheres injected subcutaneously and intramuscularly in rabbits showed a mild tissue response in vivo, in terms of the inflammatory response, the foreign body reaction and the granulation tissue response. Although an in vitro degradation experiment showed a decrease in molecular weight due to hydrolysis, the in vivo degradation of the microspheres was slower than previously published.

Giant pseudopolyposis in colitis with colonic intussusception.

When an area of giant pseudopolyp formation resulted in intussusception in a patient with known ulcerative colitis, operative intervention was required. The double contrast barium enema and fiberoptic colonoscopy were valuable complimentary diagnostic techniques in the evaluation of such a patient.