Impact of COVID-19 on follow-up and medication adherence in patients with glaucoma in a tertiary eye care centre in south India

Purpose:COVID-19 pandemic has affected the healthcare system worldwide hindering the continuum of treatment of chronic disease patients. The objective of the study is to analyze the barriers encountered by the glaucoma patients for the follow-up visit and medication adherence during the pandemic.Methods:This cross-sectional study included glaucoma patients who did not attend the scheduled appointment from April 1, 2020 to July 31, 2020 in a tertiary eye care center (88.21%). Eligible patients of age >18 years and advised antiglaucoma medication in Madurai Zone were interviewed with validated questionnaire through telephonic call.Results:363 patients answered the questionnaire through telephonic interview. 57.3% of the patients were found to be non-adherent to medication. The main barriers for glaucoma follow-up visit during the pandemic were lockdown restriction, transport problem, and financial difficulties. The top barriers for medication adherence were non availability of medication (54.81%), financial difficulties (30.29%), did not feel much improvement with eye drops (20.19%). On multiple regression analysis, longer distance to hospital, low socioeconomic status, more than one antiglaucoma medication use, lack of awareness of glaucoma, non-complaint before COVID-19 and stress due to the pandemic were found to be significant factors for medication non adherence.Conclusion:COVID-19 pandemic has emphasized the need for reformation in health care system for accessibility of medical care to patients in rural areas. Decentralization of health system to primary care level and utilization of teleophthalmology should be considered by health care planners in future.     

主动脉弓钙化影响因素的调查与分析

目的 探讨生活习惯及生理生化因素对主动脉弓钙化(AAC)的影响.方法 收集"广州生物库队列研究"第一、二期的研究对象20430名,年龄50～85岁的基线资料,体格检查、实验室检查和胸部X线的AAC诊断结果及详细的问卷调查数据;用logistic回归分析某些生活习惯及生理生化因素与AAC患病率之间的关系.结果 (1)2名高级放射诊断医师独立阅片对AAC诊断符合率为85%,Kappa值为0.68(P<0.01),显示AAC诊断是可靠的;(2)除血压外,男女性在某些生理生化特征上有明显差别(P<0.05);(3)年龄、吸烟、LDL-C及高血压是男女性患AAC的危险因素(P<0.01),其OR值(95%CI):年龄男性为1.11(1.10～1.12),女性1.12(1.12～1.13);吸烟男性为1.31(1.17～1.47),女性1.31(1.09～1.57);LDL-C男性为1.16(1.06～1.27),女性为1.38(1.22～1.56);高血压男性为1.33(1.18～1.50),女性为1.27(1.18～1.38);女性患糖尿病增加患AAC的风险(P<0.001),其OR值(95%CI)为1.38(1.22～1.56).结论 年龄、吸烟、高血压、LDL-C是患AAC的危险因素,糖尿病增加女性患AAC的风险.     

Angiotensin-converting-enzyme gene polymorphisms, smoking and chronic obstructive pulmonary disease

While tobacco smoking is the main risk factor for chronic obstructive pulmonary disease (COPD) only a fraction of smokers go on to develop the disease. We investigated the relationship between the insertion (I) – deletion (D) polymorphisms in the Angiotensin converting enzyme (ACE) gene and the risk of developing COPD in smokers by determining the distribution of the ACE genotypes (DD, ID and II) in 151 life-long male smokers. 74 of the smokers had developed COPD (62 ± 2 years; FEV₁ 44 ± 6 % reference) whereas the rest retained normal lung function (56 ± 2 yrs; FEV₁ 95 ± 3 % reference). In addition, we genotyped 159 males recruited randomly from the general population. The prevalence of the DD genotype was highest (p = 0.01) in the smokers that developed COPD and its presence was associated with a 2-fold increase in the risk for COPD (OR 2.2; IC95% 1.1 to 5.5). Surprisingly, the 151 individuals in the smoking population did not demonstrate Hardy-Weinberg equilibrium unlike the 159 recruited from the general population. Our results suggest that ACE polymorphisms are associated with both the smoking history of an individual and their risk of developing COPD.     

The Presentation and Outcome of HIV-related Disease in Nairobi

The range of clinical presentations of HIV-related disease inAfrica has not been adequately described, despite the fact thatmany hospitals have to rely heavily on clinical diagnosis. Sixhundred adult medical patients seen in the Casualty Departmentof the main Government hospital in Nairobi were enrolled ina study of the presentation and outcome of HIV-related disease:506 of these patients were admitted, of whom 19 per cent (95)were HIV seropositive. The remaining 94 were dealt with as outpatients:11 percent (10) of these were seropositive. A history of priortreatment for sexually transmitted disease and, if male, beinguncircumcised, were associated with being seropositive. Threepresentations were strongly associated with HIV infection: acutefever with no focus except the gastrointestinal tract (entericfever-like illness), acute cough with fever (community-acquiredpneumonia) and chronic diarrhoea with wasting. The WHO clinicalcase definition (CCD) for AIDS missed a substantial amount ofHIV-related morbidity (sensitivity 39 per cent) and misidentifiedmany seronegative patients (positive predictive value 59 percent). In comparison with the Centers for Disease Control surveillancedefinition for AIDS, the CCD was specific (91 per cent) andsensitive (79 per cent) but only had a positive predictive valuesof 30 per cent: the CCD may therefore be a poor surveillancetool for AIDS. Seropositive patients were much more likely todie than were seronegative patients (39 per cent vs. 15 percent mortality). Enteric fever-like illness was the presentationwhich most commonly proved fatal. A wider spectrum of diseaseis associated with underlying HIV immunosuppression than haspreviously been described in Africa.     

Staphylococcus spp., Enterobacteriaceae and Pseudomonadaceae oral isolates from Brazilian HIV-positive patients. Correlation with CD4 cell counts and viral load

The aim was to evaluate the presence of Staphylococcus spp., Enterobacteriaceae and Pseudomonadaceae in the oral cavities of HIV-positive patients. Forty-five individuals diagnosed as HIV-positive by ELISA and Western-blot, and under anti-retroviral therapy for at least 1 year, were included in the study. The control group constituted 45 systemically healthy individuals matched to the HIV patients to gender, age and oral conditions. Oral rinses were collected and isolates were identified by API system. Counts of microorganisms from HIV and control groups were compared statistically by a Mann–Whitney test (α = 5%). The percentages of individuals positive for staphylococci were similar between the groups (p = 0.764), whereas for Gram-negative rods, a higher percentage was observed amongst HIV-positive (p = 0.001).There was no difference in Staphylococcus counts between HIV and control groups (p = 0.1008). Counts were lower in the oral cavities of patients with low viral load (p = 0.021), and no difference was observed in relation to CD4 counts (p = 0.929). Staphylococcus aureus was the most frequently isolated species in HIV group, and Staphylococcus epidermidis was the prevalent species in the control group. Significantly higher numbers of enteric bacteria and pseudomonas were detected in the oral cavities of the HIV group than in the control (p = 0.0001). Enterobacter cloacae was the most frequently isolated species in both groups. Counts of enteric bacteria and pseudomonas were significantly lower in patients with low CD4 counts (p = 0.011); however, there was no difference relating to viral load. It may be concluded that HIV group showed greater species diversity and a higher prevalence of Enterobacteriaceae/Pseudomonadaceae.     

MESENTERIC FIBROMATOSIS

SUMMARY Mesenteric fibromatosis is commonly associated with Gardner's syndrome and familial polyposis. These lesions may have an insidious onset via compression of the small or large intestines, or may be noted for the first time during abdominal exploration for some other cause. Differential diagnosis may be difficult. We report a case of mesenteric fibromatosis with two recurrences, and two cases with no evidence of tumour recurrence.     

Incorporation versus infection of retroperitoneal aortic grafts: MR imaging features

The magnetic resonance (MR) imaging characteristics of normal aortic graft healing were compared with those of perigraft infection in 57 patients after aortic graft implantation. Thirty-three patients without postoperative complications underwent MR imaging in a 0.35-T unit 1 week after graft implantation, and 13 of those patients were reexamined 2-3 months after graft implantation. Twenty-four patients with clinically suspected perigraft infection underwent MR imaging 6 weeks to 18 years after graft implantation. Early normal postoperative changes were characterized by a perigraft collar of low to medium signal intensity on T1-weighted images and of high intensity on T2-weighted images in all 33 cases, consistent with perigraft fluid collection. In 10 of 13 patients reexamined 2-3 months postoperatively, the MR images demonstrated a collar of tissue consistent with perigraft fibrosis. In cases of clinical suspicion of retroperitoneal graft infection, MR imaging showed eccentric fluid collections of low to medium signal intensity on T1-weighted images and high intensity on T2-weighted images at more than 3 months after surgery. The MR findings were diagnostic of retroperitoneal perigraft infection in 17 of 20 patients shown to be infected at surgery. Retroperitoneal infection was correctly excluded on the basis of MR findings in four patients. Thus, MR imaging is an accurate imaging method for the diagnosis of aortic graft infection. In the early postoperative phase, resolving perigraft fluid cannot be differentiated from perigraft infection.