Ocular Manifestations in Patients of HIV(Human Immunodeficiency Virus) Infection on Combined Anti-Retroviral Therapy (CART).

AIM: To determine the prevalence and spectrum of ocular manifestations in PLHIV (people living with Human Immunodeficiency Virus) on cART (combined Antiretroviral Therapy) and correlate them with WHO clinical staging, CD4 count, duration & type of cART. METHODS: Observational cross-sectional study. Ophthalmic evaluation of 350 PLHIV on cART (at least 6 months) was done. Logistic regression was done to correlate ocular findings with different variables. Results: Prevalence of ocular, anterior & posterior segment manifestations was 15.71%, 10.86%, and 4.00%, respectively. Dry eye(8.00%) being the most common finding. PLHIV with CD4 count ≤350 (OR = 3.1,p < 0.001), in WHO stage 3 (OR = 26.9,p = 0.004) & 4(OR = 60.7,p < 0.001) & on 3rdlineART were at much higher risk of ocular manifestations as compared to those on 2nd (OR = 2.83) and 1stline (OR = 6.6) of therapy. Duration of treatment had a protective (p = 0.01) effect on bilateral manifestations. CONCLUSION: With early initiation of ART, there is significant reduction in the overall prevalence of ocular findings, in the number of opportunistic ophthalmic infections and blinding disorders. Of all the reported ocular findings, anterior segment disorder emerged more often.

COVID-19: The Oral and Maxillofacial Surgery Experience, Oxford, UK.

STUDY DESIGN: In response to the COVID-19 pandemic the Oxford Oral and Maxillofacial Surgery Department, that operates as a Hub and Spoke model underwent several changes to its structure to respond to the change in service. This study is an audit of all emergency patients seen during a 10-week period and compared these patients to the same time period 1-year previous. OBJECTIVE: The objective was to observe the change in the service provision during the COVID-19 pandemic. METHODS: This study prospectively recorded all the emergency referrals, inpatient admissions and emergency outpatient reviews during a 10-week period, this was compared to data from the same time period in 2019. RESULTS: The unit saw a statistically significant decrease in the number of facial lacerations (p = 0.0007) and fractured mandibles (p = 0.0067) and received a statistically significant increase in patients presenting with dental abscesses (p = 0.0067). Average length of inpatient stay was reduced from 2.4 days to 1.7; of these patients significantly less were reviewed face to face (p = 0.026) in favor of telemedicine options. CONCLUSIONS: During this period, the hub and spoke model allowed the service to quickly adapt during the COVID pandemic aiding the dissemination of new guidelines and establishing hub and spoke local consultant led daily emergency and follow up clinics. The Specialist Training Registrars were located in the central hub which allowed the service to have 24-hour resident senior decision makers and enabled the redeployment of junior doctors. The authors believe that the Hub and Spoke model allowed their workforce and resources to best serve their patient population.