Ocular Involvement of SARS-CoV-2 in a Polish Cohort of COVID-19-Positive Patients

The coronavirus SARS-CoV-2 responsible for the current human COVID-19 pandemic has shown tropism toward different organs with variable efficiency, eyes included. The purpose of this study has been to investigate the presence of detectable SARS-CoV-2 infection in ocular swabs in patients affected by COVID-19. A consecutive series of 74 COVID-19-positive patients (age 21–89) were enrolled at two Polish COVID-19 hospitals for 4 months and were characterized by PCR for the presence of the SARS-CoV-2 genetic material in nasopharyngeal (NP) and ocular swabs, while their respiratory and ocular symptoms were noted. Almost 50% of them presented with severe/critical respiratory involvement, and some degree of eye disease. No tight correlation was observed between the presence of ocular and respiratory symptoms. Three male patients presenting with severe/critical lung disease tested positive in ocular swab, however with mild/moderate ocular symptoms. In conclusion, our study lends further support to the view that overt ocular infection by the SARS-CoV-2 virus is not such a frequent occurrence.

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Ocular Involvement in COVID-19: Conjunctivitis and More

Klinische Monatsblätter für Augenheilkunde ◽

10.1055/a-1344-8138 ◽

2021 ◽

Vol 238 (05) ◽

pp. 555-560

Author(s):

Alexander C. Rokohl ◽

Rafael S. Grajewski ◽

Philomena A. Wawer Matos ◽

Adam Kopecky ◽

Ludwig M. Heindl ◽

...

Keyword(s):

Ocular Surface ◽

Symptom Relief ◽

Systemic Infection ◽

Basic Knowledge ◽

Ocular Infection ◽

Ocular Involvement ◽

Fisher Syndrome ◽

Cotton Wool Spots ◽

Ocular Symptoms ◽

Global Pandemic

AbstractSince the beginning of 2020, SARS-CoV-2, the pathogen of COVID-19, has led to a global pandemic that also affects ophthalmology. Ophthalmologists can be confronted at any time with potentially COVID-19 associated ocular symptoms or manifestations in patients and also become infected through close patient contact. Even without systemic infection, the ocular surface can come into direct contact with aerosols or liquids containing SARS-CoV-2 particles. A smear infection through hand-to-eye contact is also possible. A purely isolated ocular infection has not yet been shown. Rather, it seems that ocular complications occur in the context of a systemic infection. However, ocular symptoms can also be the first symptom of COVID-19. The most common ocular complication of COVID-19 is mild follicular conjunctivitis. Haemorrhagic conjunctivitis, dry eye disease, episcleritis, or retinal involvement can also occur less frequently. There are currently no evidence-based therapy recommendations for COVID-19 associated diseases of the ocular surface. Artificial tears might be helpful for symptom relief. There is no evidence for antiviral, antibiotic, or anti-inflammatory therapies, but these medications might be used in individual cases. Potential intraocular complications include retinal artery occlusions and haemorrhages, as well as cotton wool spots caused by complement-mediated thrombotic angiopathy. Neuro-ophthalmological complications including Miller-Fisher syndrome or infarct-related central blindness can also occur in very rare cases. Knowledge of potential transmission routes and personal protective equipment is just as essential for each ophthalmologist as a basic knowledge of potential ocular symptoms and complications.

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Frequency of efficacy of topical cyclosporine 0.05% eye drops in the management of dry eyes

10.53350/pjmhs211561384 ◽

2021 ◽

Vol 15 (6) ◽

pp. 1384-1386

Author(s):

M. Khalid ◽

M. Rizwan ◽

S. Khurshid

Keyword(s):

Dry Eye ◽

Dry Eye Disease ◽

Eye Disease ◽

Eye Drops ◽

Care Hospital ◽

Improvement Rate ◽

Female Patients ◽

Department Of Ophthalmology ◽

Male Patients ◽

Efficacy Of Treatment

Aim: To determine the efficacy of cyclosporine 0.05% for the management of patients of dry-eye disease presenting at tertiary care hospital. Methods: This cross sectional study was conducted at Department of Ophthalmology, Sahiwal Medical College, Sahiwal from March 2020 to September 2020 over the period of 6 months.Total 310 patients of dry eye were included in this study after scrutinized by inclusion criteria. All the selected patients were managed with cyclosporine 0.05% and efficacy of the drug was assessed. Results: Total 310 patients of dry eye disease were recruited. Mean age was 47.15 ± 3.61 years and mean duration of dry eye disease was 11.10 ± 1.75 months. Out of 310 patients, treatment was found effective in 225 (73%) patients. Efficacy of treatment was noted in 172(96.63%) male patients and in 53(40.15%) female patients. Significantly higher rate of efficacy was noted in male patients as compared to female patients with p value 0.000. Conclusion: Results of present study showed higher improvement rate of dry eye symptoms in cases of dry eye managed with cyclosporine 0.05%. Male patients were more victim of dry eye as compared to female patients and statistically significant association of efficacy with gender was observed. No association of efficacy of treatment with age group and duration of disease was observed. Keywords: Dry eye, cyclosporine, inflammation, immunomodulator agents.

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114. Chorioretinal Lesions in Persons Who Inject Drugs and Are Hospitalized with Bloodstream and Related Infections

Open Forum Infectious Diseases ◽

10.1093/ofid/ofz360.189 ◽

2019 ◽

Vol 6 (Supplement_2) ◽

pp. S88-S89

Author(s):

Margaret A Greven ◽

Jessica Weinstein ◽

Kathy Tsamis ◽

Philippe F Ayres ◽

Erin W Barnes ◽

...

Keyword(s):

Systemic Infection ◽

Injection Drug ◽

Ocular Involvement ◽

Persons Who Inject Drugs ◽

Disseminated Infection ◽

Drug Of Choice ◽

Cotton Wool Spots ◽

Ocular Symptoms ◽

Retinal Examination ◽

The Many

Abstract Background Eye infection is one of the many potential sites of infection in persons who inject drugs (PWID). The purpose of this study was to determine the prevalence of chorioretinal (CR) lesions, identify causative organisms, and correlate symptoms with ophthalmic involvement in PWID hospitalized with bloodstream infection (BSI) and/or related metastatic foci of infection (MFI). Methods Actively using PWID 18 years or older admitted to Wake Forest Baptist Med Ctr with documented BSI or MFI related to injection drug use (IDU) were prospectively enrolled after providing informed consent. All patients, whether or not they had eye symptoms, received a dilated retinal examination as soon as feasible after admission. Ocular symptoms, visual acuity, and ocular examination findings were recorded and fundus photos were obtained as indicated. Patients could be re-enrolled if re-admitted with a different infection. Results Fifty-three PWID with 55 episodes of disseminated infection related to IDU underwent ophthalmic exams at a median of 7 days post-admission. Mean age was 33.4 years and 51% were female. Twenty (38%) patients had HCV viremia but none had active HIV infection. Heroin was the injection drug of choice in 55% of patients. Of the 55 episodes of systemic infection, 33 were classified as infective endocarditis (IE), 6 were BSI only, 10 were BSI with MFI, and 5 were MFI without active BSI. Nine (17%) patients had CR involvement on examination but only 33% (3/9) were symptomatic. Of those with ocular involvement, 1 had fungal endophthalmitis due to Candida albicans. Single or multifocal subretinal infiltrates were found in 5/9 patients (MSSA 2, MRSA 2, H. parainfluenzae 1), 2/9 had cotton wool spots (S. mitis 1, MRSA 1), and 7/9 had intraretinal or white-centered hemorrhages (MSSA 3, MRSA 2, S. mitis 1, H. parainfluenzae 1). Of the 9 patients with CR lesions, 7 had IE. Interestingly, 3.8% (3/53) had old multifocal CR scars, possibly related to prior disseminated infection. Conclusion PWID admitted with BSI or MFI may have ophthalmic involvement even in the absence of ocular symptoms, especially in the setting of IE. Further study is needed to characterize the epidemiology of these infections, to identify risk factors for ocular involvement, and to optimize diagnosis and management. Disclosures All authors: No reported disclosures.

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An Eleven-Year Retrospective Study of Endogenous Bacterial Endophthalmitis

Journal of Ophthalmology ◽

10.1155/2015/261310 ◽

2015 ◽

Vol 2015 ◽

pp. 1-11 ◽

Cited By ~ 21

Author(s):

Takashi Nishida ◽

Kyoko Ishida ◽

Yoshiaki Niwa ◽

Hideaki Kawakami ◽

Kiyofumi Mochizuki ◽

...

Keyword(s):

Visual Outcome ◽

Causative Organism ◽

Ocular Involvement ◽

Bacterial Endophthalmitis ◽

Poor Visual Outcome ◽

Ocular Symptoms ◽

Good Visual Outcome ◽

The Mean ◽

Systemic Antibiotics ◽

Endogenous Bacterial Endophthalmitis

Purpose. To determine the clinical features, microbial profiles, treatment outcomes, and prognostic factors for endogenous bacterial endophthalmitis (EBE).Methods. The medical records of 27 eyes of 21 patients diagnosed with EBE for 11 years were reviewed. Collected data included age, site of infection, visual acuities (VAs), microbial profiles, and treatment regimen.Results. The mean age was 68.5 years. Gram-positive organisms accounted for 76.2%, while gram-negative ones accounted for 19.0%.Staphylococcus aureuswas the most common causative organism (52.3%) of which 72.7% wasmethicillin-resistant S. aureus. A final VA of ≥20/40 was achieved in 44% and 20/200 or better was in 64%. Eyes with initial VA of ≥20/200 (P= 0.003) and focal involvements (P= 0.011) had significantly better final VA. Initial VA (P= 0.001) and the interval between onset of ocular symptoms and intravitreal antibiotic injection (P= 0.097) were associated with final VA in eyes receiving intravitreal antibiotics.Conclusions. EBE is generally associated with poor visual outcome; however the prognosis may depend on initial VA, extent of ocular involvement, and an interval between onset of ocular symptoms and intravitreal antibiotic injection. Early diagnosis and early intravitreal injection supplement to systemic antibiotics might lead to a relatively good visual outcome.

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Hysterical traits are not from the uterus but from the testis: A study in men with sexual dysfunction

European Psychiatry ◽

10.1016/s0924-9338(11)73244-8 ◽

2011 ◽

Vol 26 (S2) ◽

pp. 1540-1540

Author(s):

E. Bandini ◽

V. Ricca ◽

A.D. Fisher ◽

G. Corona ◽

M. Maggi

Keyword(s):

Blood Flow ◽

Sexual Dysfunction ◽

Sexual Functioning ◽

Well Being ◽

Structured Interview ◽

Consecutive Series ◽

Psychiatric Setting ◽

Middlesex Hospital ◽

Testis Volume ◽

Male Patients

IntroductionThe relationship between testosterone (T) and psychopathology in subjects with sexual dysfunction has not been completely clarified.Objectives and aimsTo evaluate the association between T levels and different psychopathological symptoms and traits in men seeking treatment for sexual dysfunction.MethodsA consecutive series of 2,042 heterosexual male patients consulting an outpatient clinic for sexual dysfunction was retrospectively studied. Several hormonal, biochemical, and instrumental parameters were investigated, including testis volume and penile blood flow. Patients were interviewed, prior to the beginning of any treatment, with the previously validated Structured Interview on Erectile Dysfunction (SIEDY), and ANDROTEST (a structured interview for the screening of hypogonadism in patients with sexual dysfunction). They also completed the Middlesex Hospital Questionnaire (MHQ) a brief self-reported questionnaire for the screening of the symptoms of mental disorders in non psychiatric setting.ResultsT levels showed a negative correlation with depressive and anxiety symptoms. Conversely, histrionic/hysterical traits were strongly and positively associated with elevated T. Men with histrionic/hysterical traits had higher androgenization, as suggested by higher total and free T, higher testis volume and a lower ANDROTEST score. They were also characterized by better self-reported sexual functioning and penile blood flow.ConclusionsIn men consulting for sexual dysfunction, histrionic/hysterical traits are associated with higher androgenization and better sexual functioning. Hysteria, previously considered as a typically feminine psychopathological trait, should now be considered as an index of better masculine sexual well-being.

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Identification of SARS-CoV-2 RNA in the conjunctival swab of an Italian pediatric patient affected with COVID-19: A case report

European Journal of Ophthalmology ◽

10.1177/1120672120977822 ◽

2020 ◽

pp. 112067212097782

Author(s):

Luciano Quaranta ◽

Francesca Rovida ◽

Ivano Riva ◽

Carlo Bruttini ◽

Ilaria Brambilla ◽

...

Keyword(s):

Case Report ◽

Severe Acute Respiratory Syndrome ◽

Pediatric Patient ◽

Ocular Involvement ◽

Case Description ◽

Rt Pcr ◽

Reverse Transcription Pcr ◽

Ocular Symptoms ◽

Pediatric Clinic ◽

Conjunctival Swab

Introduction: To report a case of identification of Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) RNA in ocular specimen in a pediatric patient affected with Coronavirus disease 2019 (COVID-19) with no signs of ocular involvement. Case description: A 11-year old male patient with confirmed COVID-19 infection was hospitalized at the Pediatric Clinic Clinic of the IRCCS Foundation and Hospital San Matteo, Pavia, Italy. Three days after hospital admission, because of the patient complaining very mild ocular symptoms, an ophthalmological evaluation was performed. No signs related to conjunctivitis or keratitis were found but a conjunctival swab was collected as well, based on patient’s medical history. The specific SARS-CoV-2 reverse transcription PCR (RT-PCR) was performed, unearthing the presence of viral RNA from the swab. On day 25 from hospitalization, the conjunctival swab was repeated, giving negative result. Conclusions: This is the first report of the identification of SARS-CoV-2 RNA in ocular specimen in a pediatric patient without signs of ocular involvement. However, despite the transmission through tears is theoretically possible, it is still unclear whether this could be considered as an important route for the spread of SARS-CoV-2.

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Thin Basement Membrane Nephropathy: Diffuse and Segmental Types

Archives of Pathology & Laboratory Medicine ◽

10.5858/2006-130-1533-tbmnda ◽

2006 ◽

Vol 130 (10) ◽

pp. 1533-1537

Author(s):

Bela Ivanyi ◽

Robert Pap ◽

Zoltan Ondrik

Keyword(s):

Basement Membrane ◽

Direct Measurement ◽

Measurement Technique ◽

Consecutive Series ◽

Variable Degree ◽

Thin Basement Membrane Nephropathy ◽

Quantitative Expression ◽

Number Of Patients ◽

Male Patients ◽

Global Glomerulosclerosis

Abstract Context.—Diffuse thinning of the glomerular basement membrane (GBM) is the ultrastructural diagnostic criterion of thin basement membrane nephropathy (TBMN). However, there is no consensus regarding what diagnosis should be made if the attenuation is segmental. Objective.—To develop a diagnostic approach to TBMN in cases with segmental GBM thinning. Design.—We compared the diagnostic sensitivities of 2 methods used for the quantitative expression of GBM width in a consecutive series of renal biopsies from 26 patients (median age, 36 years; range, 15 to 59 years) with dysmorphic hematuria (a variable degree of proteinuria in 19 patients), a thin GBM, and absence of other renal disease. The harmonic GBM width was determined from orthogonal intercepts, and the actual width in the thinnest loops was obtained by direct measurement. The GBM attenuation was categorized into diffuse or segmental types by conventional inspection. Results.—Segmental TBMN accounted for one third of the series. In neither type did the male patients have a higher harmonic mean GBM width than the female patients. Focal-global glomerulosclerosis was more common in diffuse TBMN. The laborious orthogonal intercept method proved insensitive for the verification of segmental TBMN, whereas the much simpler direct measurement technique captured all the cases. Conclusions.—A considerable number of patients with TBMN display segmental GBM attenuation. Because the routine criterion excludes these cases from the diagnosis, we propose to define TBMN as a clinicopathologic entity of dysmorphic hematuria and a diffusely or segmentally thinned GBM confirmed by the direct measurement technique.

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Evaluation of the respiratory function in myasthenia gravis: an important tool for clinical feature and diagnosis of the disease

Arquivos de Neuro-Psiquiatria ◽

10.1590/s0004-282x1996000400009 ◽

1996 ◽

Vol 54 (4) ◽

pp. 601-607 ◽

Cited By ~ 2

Author(s):

Paulo A. P. Saraiva ◽

José Lamartine de Assis ◽

Paulo E. Marchiori

Keyword(s):

Lung Function ◽

Myasthenia Gravis ◽

Neuromuscular Diseases ◽

Point Of View ◽

Clinical Feature ◽

Respiratory Involvement ◽

Ocular Myasthenia Gravis ◽

Male Patients ◽

Expiratory Muscles ◽

Almost All

Myasthenic gravis may affect both inspiratory and expiratory muscles. Respiratory involvement occurred in almost all patients with myasthenia gravis in all clinical forms of the disease: 332 lung function tests done in 324 myasthenic patients without respiratory symptoms (age 34.6 ± 18.3 years) were examined. Lung volumes analysis showed that all the patients of both sexes with generalized or ocular myasthenia gravis showed "myasthenic pattern". Male patients with "ocular" form only presented the "myasthenic pattern" with lung impairment and had, from the lung function point of view, a more benign behaviour. Female patients with the "ocular" form exhibited a behaviour of respiratory variables similar to that of the generalized form. It was not observed modification of the variables that suggested obstruction of the higher airways. The "myasthenic pattern" was rarely observed in other neuromuscular diseases, except in patients with laryngeal stenosis.

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Relation among aneurysm size, amount of subarachnoid blood, and clinical outcome

Journal of Neurosurgery ◽

10.3171/jns-07/07/0013 ◽

2007 ◽

Vol 107 (1) ◽

pp. 13-17 ◽

Cited By ~ 39

Author(s):

Montell Salary ◽

Matthew R. Quigley ◽

Jack E. Wilberger

Keyword(s):

Anterior Communicating Artery ◽

Consecutive Series ◽

Aneurysm Size ◽

Clinical Series ◽

Computed Tomography Scans ◽

Male Patients ◽

The Mean ◽

Arachnoid Hemorrhage ◽

Subarachnoid Blood ◽

Independent Determinant

Object The authors of recent reports have suggested that smaller aneurysms are associated with more extensive sub-arachnoid hemorrhage (SAH), which could potentially presage poor outcome in patients harboring these lesions. The authors reviewed their clinical experience to determine if this theory has a basis in truth. Methods The authors undertook a retrospective review of a consecutive series of patients with aneurysmal SAH. Computed tomography scans and angiograms were studied to establish SAH scores and aneurysm size. Results One hundred thirty-three patients were treated during a 2-year period (January 2003–December 2004). There were 101 female and 32 male patients whose mean age was 56.7 years. The location distribution of aneurysms that bled was as follows: anterior communicating artery (56 cases), posterior communicating artery (34 cases), middle cerebral artery (21 cases), posterior circulation (16 cases), and paraclinoid region (six cases). The mean aneurysm size was 6.2 mm (range 2–26 mm). The mean SAH score was 18.3 (not normally distributed, p < 0.01, D'Agostino–Pearson test). One hundred three patients underwent surgical exploration and placement of an aneurysm clip, 21 underwent deployment of a coil, and two underwent both therapies; seven patients died prior to intervention. No correlation was found between aneurysm size and SAH score (rS = −0.023, p = 0.8) or between small aneurysm size and poor Glasgow Outcome Scale score (p = 0.13). In fact, the trend was the opposite. The SAH score did, however, correspond strongly with the admission Hunt and Hess grade (p < 0.0001), indicating the strong correlation between grade and volume of intracranial blood. Outcome was best explained in the multivariate analysis by the following factors: admission Hunt and Hess grade, age, and clinical vasospasm (p < 0.0001) with the proportion of cases correctly classified as 79.7%. Conclusions Evaluation of the results in the present clinical series suggests that there is no relation between aneurysm size and volume of subarachnoid blood. The volume of cisternal blood correlates with Hunt and Hess grade but is not an independent determinant of outcome. Outcome is related to the following triad of well-established clinical factors: Hunt and Hess grade, age, and clinical vasospasm.

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Patterns and Implications of Early Syndesmotic Screw Failure in Rotational Ankle Fractures

Foot & Ankle International ◽

10.1177/1071100720935119 ◽

2020 ◽

Vol 41 (9) ◽

pp. 1065-1072

Author(s):

Omar A. Behery ◽

Jessica Mandel ◽

Sara J. Solasz ◽

Sanjit R. Konda ◽

Kenneth A. Egol

Keyword(s):

Clinical Outcome ◽

Range Of Motion ◽

Ankle Fractures ◽

Consecutive Series ◽

Retrospective Case ◽

Level Of Evidence ◽

Patient Demographics ◽

Syndesmotic Screw ◽

Screw Breakage ◽

Male Patients

Background: The purpose of this study was to identify characteristic patterns of syndesmotic screw (SS) failure, and any effects on clinical outcome. Methods: A retrospective study was performed using a consecutive series of patients treated with open reduction and internal fixation with trans-syndesmotic screws for unstable ankle fractures with syndesmotic injury between 2015 and 2017. Patient demographics, fracture characteristics and classification, rates and patterns of trans-syndesmotic screw breakage, and backout were analyzed. Functional outcome was assessed using passive range of motion (ROM) and Maryland Foot Score (MFS). Results: A total of 113 patients (67%) had intact screws and 56 patients (33%) demonstrated either screw breakage or backout. Patients with SS failure were younger ( P = .002) and predominantly male ( P = .045). Fracture classification and energy level of injury were not associated with screw failure. Nine screws (11%) demonstrated backout (2 also broke) and 56 other screws broke. There was no association between the number of screws or cortices of purchase and screw failure. There was a trend toward a higher proportion of screw removal (20%) in this failed SS group compared with the intact SS group (12%) ( P = .25), but with similar ankle ROM and MFS ( P > .07). Conclusion: Syndesmotic screw breakage was common in younger, male patients. Despite similarities in ankle range of motion and clinical outcome scores to patients with intact screws, there was a trend towards more frequent screw removal. This information can be used to counsel patients pre- and postoperatively regarding the potential for screw failure and subsequent implant removal. Level of Evidence: Level III, retrospective case-control study.

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