Retinopathy of prematurity: Past,present and future

Retinopathy of prematurity (ROP) is a vasoproliferative disorder of the retina occurring principally in new born preterm infants. It is an avoidable cause of childhood blindness. With the increase in the survival of preterm babies, ROP has become the leading cause of preventable childhood blindness throughout the world. A simple screening test done within a few weeks after birth by an ophthalmologist can avoid this preventable blindness. Although screening guidelines and protocols are strictly followed in the developed nations, it lacks in developing economies like India and China, which have the highest number of preterm deliveries in the world. The burden of this blindness in these countries is set to increase tremendously in the future, if corrective steps are not taken immediately. ROP first emerged in 1940s and 1950s, when it was called retrolental fibroplasia. Several epidemics of this disease were and are still occurring in different regions of the world and since then a lot of research has been done on this disease. However, till date very few comprehensive review articles covering all the aspects of ROP are published. This review highlights the past, present and future strategies in managing this disease. It would help the pediatricians to update their current knowledge on ROP.     

《松峰说疫》疫病预防思想探析

《松峰说疫》是清代刘奎的一部较为全面论述疫病的中医温病著作,其中蕴含有丰富的疫病预防思想。通过系统挖掘与整理其中相关内容,从疫病预防的理论认识、治则治法与具体方药等方面,以全面阐述《松峰说疫》疫病预防思想体系,可为当前防治疫病提供借鉴。     

新型冠状病毒肺炎疫情期间消化科工作防护要点

2019年12月来,武汉暴发的新型冠状病毒肺炎席卷全国,并列为国际关注的公共卫生紧急事件。根据既往对其他冠状病毒研究结果和消化科诊疗活动特点,对新型冠状病毒肺炎疫情期间消化科工作防护要点进行了细化总结,供消化科一线工作人员临床参考。     

Épidémies,contagiosité et idéologie au XIXe siècle… et au-delà

With the title “Anticontagionism between 1821–1867”, Erwin Ackerknecht's 1948 Fielding Garrison lecture to the American Association for the History of Medicine marked a milestone in the history of medicine by showing how medicine could be influenced by politics and ideology. His account tells of the quarrel, particularly lively in France, between supporters and opponents of contagionism, a quarrel which led to the official doctrine that major epidemic diseases were not contagious (this doctrine in the form of dogma was only abandoned at the end of the century thanks to the progress of medical knowledge). The order in which the Academy of Medicine reviewed the reports it had requested is important, from the first when Étienne Pariset was sent to Spain to study two epidemics of yellow fever and wrongly asserted the contagious nature of the infection (and this assertion was quickly challenged) to the second when it became aware of the unanimous anticontagionist reports of French doctors who had been working in Egypt on the victims of the plague epidemic of 1834–1835. The Academy, i.e. the elite of the profession, had forged an anticontagionist conviction which it asserted during the cholera epidemic of 1832 neglecting the contrary opinion of provincial practitioners. The anticontagionist dogma – and this is Ackerknecht's interpretation – came from the bourgeois and liberal convictions of its supporters. They considered contagionism to be a medieval doctrine which, in their view, neglected the lamentable living and housing conditions of the poorest, those who were the most numerous victims of the epidemics. Their liberal criticism also concerned the organisation of quarantines, which were considered inefficient and blocked trade. We would add that it was an elite with generous intentions and that it had cut itself off from ordinary people. The example of the recent epidemic of cholera in Haiti shows the ever-present risk of medical contamination by ideology and politics, and the absolute necessity of confronting theories with facts.     

Validation of the Japanese version of Stress and Anxiety to Viral Epidemics-9 (SAVE-9) and relationship among stress,insomnia, anxiety,and depression in healthcare workers exposed to coronavirus disease 2019

ObjectiveThis study aimed to validate the Japanese version of the 9-item Stress and Anxiety to Viral Epidemics scale (SAVE-9) and the relationships among the stress related to viral epidemics, insomnia, anxiety, and depression.Patients/methodsA cross-sectional questionnaire-based study was conducted online. In total, 1000 healthcare workers (579 men, 421 women; mean age: 43.11 ± 11.69 years) were asked to complete the SAVE-9, Athens Insomnia Scale, Generalized Anxiety Disorder-7 Scale, and Center for Epidemiological Studies Depression Scale. For the analysis, participants were divided into two groups: healthcare workers at a medical institution designated for COVID-19 (COVID institution) and those working at an institution not designated for COVID-19 (non-COVID institution).ResultsItem response theory analysis showed that the SAVE-9 and SAVE-6 (6-item version) had good structural validity and internal consistency (ω = 0.91 and 0.93). Correlation analysis for convergent validity showed a significant positive correlation between both the SAVE-9 and SAVE-6 and the other scales for insomnia, anxiety, and depression. In addition, both SAVE-9 and SAVE-6 scores were higher for workers in COVID institutions than for those in non-COVID institutions. Furthermore, stress related to viral epidemics was found to directly affect anxiety (β = 0.48) and depression (β = 0.25) and indirectly affect anxiety (β = 0.37) and depression (β = 0.54) via insomnia (β = 0.33).ConclusionsThis study confirmed that the reliability and validity of both the SAVE-9 and SAVE-6 and that insomnia mediated the effects of stress to viral epidemics on anxiety and depression symptoms.     

The impact of social isolation by COVID-19 on the epidemiological and clinical profiles of the burn patients. A retrospective study

BackgroundSocial isolation, imposed by the COVID-19 pandemic, may imply changes in the clinical-demographic and epidemiological profiles of burn trauma victims.ObjectiveEvaluate the changes in the epidemiological profile of patients with burns that resulted in hospitalization during the social isolation period due to the COVID-19 pandemic, comparing with the same period in the previous year.MethodsThe medical records of burn patients who were hospitalized in our Burn Center during the local confinement period (March 18th to August 31st, 2020) and during the same period in 2019 were analyzed. Data on demographic, clinical and hospitalization aspects were studied.Results470 patients were evaluated. In the pediatric population, a significant increase in the number of cases up to 2 years old (P = 0.0003), median of %TBSA (P = 0.037), full-thickness burns (P < 0.0001), involvement of hands (P = 0.024), debridement (P = 0.046) and grafting (P = 0.032) procedures, and higher scores of severity (P < 0.0001) were noted. In the adult population, it was only observed an increase in the burn-hospitalization interval (P = 0.029).ConclusionThe pediatric population was heavily impacted by the imposed period of social isolation, presenting a greater severity of burns. In contrast, the epidemiology of burns for the adult population was slightly altered during the pandemic period.     

Molecular and point-of-care diagnostics for Ebola and new threats: National POCT policy and guidelines will stop epidemics

Introduction: US hospitals that admitted Ebola virus disease (EVD) patients mitigated risk by using point-or-care testing (POCT) for critical support in isolation units. Success proved unequivocally the need for POCT. Additionally, molecular diagnostics have been used to help stop new outbreaks, and even handheld diagnostic solutions are emerging.

Areas covered: This update of ‘Molecular detection and point-of-care testing in Ebola virus disease and other threats’ [Expert Reviews 2015;15(10):1249–1255], assesses the impact of EVD epidemics, documents insights from recent reviews, summarizes evolving POC molecular technologies, presents General Accountability Office (GAO) recommendations, identifies the role of POC Coordinators, and casts a vision for national POCT policies and guidelines. Factual updating comprised summarizing EVD outbreaks including 2017–2018, analyzing reviews and evidence-based publications since the 2014–2016 epidemic, and tabulating published technical and molecular diagnostics. New graphics illustrate POC error mitigation/risk reduction, a framework for national POCT policy and guidelines, modular adaptations for country-specific solutions, and a logic diagram for future progress embedding artificial intelligence.

Expert commentary: The USA is still not prepared for highly infectious diseases. Key is lack of community rapid response and resilience, which must be enhanced not via mechanisms distant, but instead by molecular diagnostics directly at critical points of need.     

重庆市一起学校肺结核聚集性疫情调查分析

目的: 对重庆市一起学校肺结核疫情进行调查和分析,为强化学校结核病防控工作提供思路和建议。方法: 采用描述性流行病学方法,对重庆市2020年12月至2021年5月一起学校肺结核疫情进行流行病学调查和分析。采用症状筛查、结核菌素皮肤试验(tuberculin skin test,TST)和胸部X线摄片(简称“胸片”)开展肺结核筛查,并对接触者开展流行病学调查。结果: 在确诊1例病原学阳性肺结核病例(指示病例)后,经过4次接触者筛查及1次随访检查,检出8例活动性肺结核患者和42例结核分枝杆菌潜伏感染者。校内8例学生患者均集中在指示病例所在班级,该班肺结核罹患率为12.7%(8/63),病原学阳性者占2/8,结核分枝杆菌潜伏感染者34例,潜伏感染率为61.8%(34/55),均全部完成预防性治疗。指示病例所在班级学生发病风险和感染风险均高于其他班级(RR=27.6,95%CI:13.5~56.4)。校内8例学生肺结核患者中,男生6例,女生2例,年龄分布以15岁组最多(6例)。因首次接触者筛查胸片质量差,未能及时发现学生患者,导致后续因症就诊发现3例患者。2例学生潜伏感染者因未规范服药,在预防性治疗期间转为肺结核患者。 结论: 本次肺结核疫情聚集性明显,筛查质量低、未能规范完成预防性治疗是疫情蔓延的重要原因。在处置学校肺结核疫情时,应提高筛查质量,根据流行病学调查情况充分考虑窗口期问题,保证预防性治疗的规范性和完成率。