The impact of COVID-19 on rheumatology patients in a large UK centre using an innovative data collection technique: prevalence and effect of social shielding.

OBJECTIVES: We sought to gain insight into the prevalence of COVID-19 and the impact stringent social distancing (shielding) has had on a large cohort of rheumatology (RD) follow-up patients from a single large UK centre. METHODS: We linked COVID-19-related deaths, screening and infection rates to our RD population (1.2.20-1.5.20) and audited active rheumatology follow-up patients through survey data communicated via a linked mobile phone SMS message. We assessed epidemiology, effect of stringent social distancing (shielding) and quality of life (HRQoL) by Short Form 12 (SF12). RESULTS: There were 10,387 active follow-up patients, 7911 had linked mobile numbers. 12/10,387 RD patients died from COVID-19 (0.12%); local population 4131/7,415,149 (0.12%). For patients with mobile phones, 1693/7911 (21%) responded and of these, 1605 completed the SF12. Inflammatory arthritis predominated 1174/1693 (69%); 792/1693 (47%) were shielding. Advice on shielding/distancing was followed by 1372/1693(81%). 61/1693 (4%) reported COVID-19 (24/61 shielding); medication distribution was similar in COVID and non-COVID patients. Mental SF12 (MCS) but not physical (PCS) component scores were lower in COVID (60) vs. non-COVID (1545), mean differences: MCS, - 3.3; 95% CI - 5.2 to - 1.4, P < 0.001; PCS, - 0.4; 95% CI, - 2.1 to 1.3). In 1545 COVID-negative patients, those shielding had lower MCS (- 2.1; 95% CI - 2.8 to - 1.4) and PCS (- 3.1, 95% CI - 3.7 to - 2.5), both P < 0.001. CONCLUSIONS: Our full RD cohort had no excess of COVID deaths compared to the general local population. Our survey data suggest that shielding adversely affects both mental and physical health in RD. These data broaden our understanding of shielding, indicating need for further study.

Cataract surgery assisted by anterior endoscopy.

AIM: The aim of the present study is to evaluate the feasibility of endoscopy-assisted phacoemulsification, intraocular lens (IOL) implantation and anterior segment manoeuvres like synechiotomy where conventional surgery through a microscope view was not possible due to corneal opacification. METHODS: This is a prospective, non-comparative, case report series of nine consecutive patients who underwent endoscopy-assisted anterior segment surgery in Al Bahar Eye Center in Kuwait. A fused fibre-optic type of endoscope was used to aid in performing phacoemulsification, to identify the position of haptics of IOL and synechiotomy. RESULTS: Out of a total of nine patients, seven patients underwent endoscopic-assisted phacoemulsification. In case 7, the endoscope was used to sever irido-corneal synechae. In case 8, the endoscope was used to identify the position of the haptics of IOL in a partially dilated pupil. In case 9, endocyclophotocoagulation (ECP) was done after phacoemulsification. Vision improvement occurred in all cases. No intraoperative or postoperative complications related to either the surgery or the use of the endoscope were observed. CONCLUSION: The ophthalmic microendoscope appears to be safe and effective in simultaneously providing illumination, video recording and a clear endoscopic view of the anterior chamber. This study demonstrates that in selected cases, anterior segment endoscopy is a useful adjuvant to cataract surgery.

Bilateral frosted branch angiitis and cytomegalovirus retinitis in acquired immunodeficiency syndrome.

This report describes a case of frosted branch angiitis associated with AIDS.

Interrelation between Systemic Lupus Erythematosus and Thrombotic Thrombocytopenic Purpura.

Features suggestive of thrombotic thrombocytopenic purpura (TTP) are known to occur in patients with systemic lupus erythematosus (SLE). We report a patient who had TTP which resolved with plasma exchange and immunosuppression, but presented three years later with features of SLE. The diagnosis satisfied all the required criteria in both instances. The interrelationship between the two conditions is discussed.