Relative Importance of Glaucoma-Referral Indicators in Retinal Images in a Diabetic Retinopathy Screening Programme in Slovenia: A Cross-Sectional Study.

Background and Objectives: Glaucoma is a major cause of irreversible visual impairment and blindness, so its timely detection is crucial. Retinal images from diabetic retinopathy screening programmes (DRSP) provide an opportunity to detect undiagnosed glaucoma. Our aim was to find out which retinal image indicators are most suitable for referring DRSP patients for glaucoma assessment and to determine the glaucoma detection potential of Slovenian DRSP. Materials and Methods: We reviewed retinal images of patients from the DRSP at the University Medical Centre Ljubljana (November 2019-January 2020, May-August 2020). Patients with at least one indicator and some randomly selected patients without indicators were invited for an eye examination. Suspect glaucoma and glaucoma patients were considered accurately referred. Logistic regression (LOGIT) with patients as statistical units and generalised estimating equation with logistic regression (GEE) with eyes as statistical units were used to determine the referral accuracy of indicators. Results: Of the 2230 patients reviewed, 209 patients (10.1%) had at least one indicator on a retinal image of either one eye or both eyes. A total of 149 (129 with at least one indicator and 20 without) attended the eye exam. Seventy-nine (53.0%) were glaucoma negative, 54 (36.2%) suspect glaucoma, and 16 (10.7%) glaucoma positive. Seven glaucoma patients were newly detected. Neuroretinal rim notch predicted glaucoma in all cases. The cup-to-disc ratio was the most important indicator for accurate referral (odds ratio 7.59 (95% CI 3.98-14.47; p < 0.001) and remained statistically significant multivariably. Family history of glaucoma also showed an impact (odds ratio 3.06 (95% CI 1.02-9.19; p = 0.046) but remained statistically significant only in the LOGIT multivariable model. Other indicators and confounders were not statistically significant in the multivariable models. Conclusions: Our results suggest that the neuroretinal rim notch and cup-to-disc ratio are the most important for accurate glaucoma referral from retinal images in DRSP. Approximately half of the glaucoma cases in DRSPs may be undiagnosed.

Reasons for the low influenza vaccination rate among nurses in Slovenia.

AIM: This study aimed to identify nurses' views on influenza vaccination and factors that might explain why they do not receive influenza vaccinations, and to examine any ethical issues encountered in the vaccination process. BACKGROUND: All 27 European Union member states and 2 other European countries recommended influenza vaccinations for healthcare workers in 2014-15. Data show that the influenza vaccination rate among nurses in Slovenia is even lower than in other European countries. Slovenian study showed that 41.7% of the respondents had received both the pandemic and the seasonal vaccine. Doctors had the highest level of vaccine coverage, with 44.1%, followed by registered nurses at 23.4%, whereas the lowest level was found among nursing assistants and nursing technicians (17%) at a Ljubljana health clinic. METHODS: A qualitative study was carried out. Nineteen nurses who did not receive influenza vaccination took part in the study. Thematic interviews were conducted in December 2018. Interview transcripts were read, coded, reviewed and labelled by three independent researchers. The collected material was processed using qualitative content analysis. FINDINGS: Thirteen categories and four themes were identified and coded, which enabled an understanding of the nurses' views regarding influenza vaccination. Most of their experiences were positive in one way: they recognised the importance of vaccination and people's awareness of it. However, they did not obtain the influenza vaccine themselves. The main barriers to vaccination were doubt regarding the vaccine's effectiveness, the potential for side effects, the belief that young healthcare professionals are well protected and not at high risk, an overrated trust in their own immune systems, and the belief that pharmaceutical industry marketing was targeting them. The nurses suggested several ways that vaccination could be promoted and improved vaccination coverage achieved. These findings call attention to the importance of recognising both the need for targeted information for the nurses and the need for different approaches to healthcare provision.

A case of recurrent MOG antibody positive bilateral optic neuritis and anti-NMDAR encephalitis: Different biological evolution of the two associated antibodies.

We report the clinical association of myelin-oligodendrocyte-glycoprotein (MOG) IgG-associated encephalomyelitis (MOG-EM) and anti-N-methyl-d-aspartate receptor (NMDAR) encephalitis. A 47-year old male presented to our hospital with right eye optic neuritis in February 2018. He had a history of recurrent bilateral optic neuritis since 2001 and in 2013 was treated of a anti-NMDAR encephalitis. He never had any CNS demyelination event besides optic neuritis. At the time of anti-NMDAR encephalitis both NMDAR and MOG antibodies were positive in serum and CSF. At the last visit, serum aquaporin-4 (AQP-4) and NMDAR antibodies were negative but MOG antibodies remained positive. MOG-EM and NMDAR encephalitis can present over an extended period of time without other signs of CNS demyelination and with a different temporal evolution of the associated antibodies.