Risk factors for the progression of trachomatous scarring in a cohort of women in a trachoma low endemic district in Tanzania

Background Trachoma, a chronic conjunctivitis caused by Chlamydia trachomatis, is the leading infectious cause of blindness worldwide. Trachoma has been targeted for elimination as a public health problem which includes reducing trachomatous inflammation—follicular prevalence in children and reducing trachomatous trichiasis prevalence in adults. The rate of development of trachomatous trichiasis, the potentially blinding late-stage trachoma sequelae, depends on the rate of trachomatous scarring development and progression. Few studies to date have evaluated the progression of trachomatous scarring in communities that have recently transitioned to a low trachomatous inflammation—follicular prevalence. Methodology/Principal findings Women aged 15 and older were randomly selected from households in 48 communities within Kongwa district, Tanzania and followed over 3.5 years for this longitudinal study. Trachomatous inflammation—follicular prevalence was 5% at baseline and at follow-up in children aged 1–9 in Kongwa, Tanzania. 1018 women aged 15 and older had trachomatous scarring at baseline and were at risk for trachomatous scarring progression; 691 (68%) completed follow-up assessments. Photographs of the upper tarsal conjunctiva were obtained at baseline and follow-up and graded for trachomatous scarring using a previously published four-step severity scale. The overall cumulative 3.5-year progression rate of scarring was 35.3% (95% CI 31.6–39.1). The odds of TS progression increased with an increase in age in women younger than 50, (OR 1.03, 95% CI 1.01–1.05, p = 0.005) as well as an increase in the household poverty index (OR 1.29, 95% CI 1.13–1.48, p = 0.0002). Conclusions/Significance The 3.5-year progression of scarring among women in Kongwa, a formerly hyperendemic now turned hypoendemic district in central Tanzania, was high despite a low active trachoma prevalence. This suggests that the drivers of scarring progression are likely not related to on-going trachoma transmission in this district.

Features of the Clinical Course and Treatment of Dry Eye Syndrome in the Setting of Chronic Conjunctivitis in the South Aral Sea Region

Background. Currently, the health status of the population in the Aral Sea region should be considered with reference to long-term effects of environmental pollution – air, soil and drinking water containing toxic salts. As per results of the analysis of primary eye diseases in the Southern Aral Sea region, it was revealed that the main cause of conjunctivitis were chemical and physical exogenous irritation factors, such as dust, smoke and exposure to salt and sand storms that create a favorable environment for infection and development of secondary Dry Eye Syndrome. Purpose. To optimize treatment of secondary Dry Eye Syndrome (DES) in patients with chronic conjunctivitis in the South Aral Sea region. Materials and Methods. The research included 62 patients (120 eyes) with chronic conjunctivitis, aged 35–62 years, who had been observed in an outpatient clinic for the last 3 years, with signs of DES. All studied patients were divided into 2 groups by random sampling after preliminary adequate antibacterial and anti-inflammatory therapy. The control group (20 patients, 40 eyes) was instilled with Tsinosol antiseptic (composition: zinc sulphate, boric acid, Aseptic) – 2 drops 3 times a day, during 30 days. Patients of the main group (42 patients, 80 eyes) were instilled with Tsinosol antiseptic (2 drops 3 times a day) and Keratrop artificial tear (AT) eye drops (composition: sodium carmellose, glycerin, levocarnitine, erythrol, firma Aseptica) – 2 drops 3 times a day, during a month. All patients underwent standard ophthalmological tests, and special tests were carried out to verify DES, including Schirmer, Norn and Jones tests. Lower lacrimal meniscus height and the severity of the conjunctival fold were also determined. Results. Studies have shown that in the main group, both subjective and objective signs of the disease significantly decreased compared with the baseline and with the respective parameters of the control group, and a significant improvement in the stability of the tear film was noted. Conclusion. To optimize the therapy of secondary DES, it is necessary to include artificial tear eye drops in the treatment regimen in general, and consider using Keratrop eye drops in particular.

Long-term consequences of Lyell's syndrome suffered in childhood

The article provides a review of literature on the long-term consequences of Lyell's syndrome (one of the forms of toxic epidermal necrolysis). Among them: chronic eczema with xerosis and itching, skin depigmentation, hypertrophic and keloid scars, nail lesions, eyes, including dry eye syndrome and chronic conjunctivitis with/without obliteration of the nasolacrimal canal, kidney disease, lung disease, Sjogren's syndrome, Hashimoto's thyroiditis and others. Clinical case. The authors present their clinical case of an 11-year-old girl who suffered from Lyell's syndrome at the age of 8 and has been observed for the past three years, share their clinical and laboratory-instrumental observations and treatment strategies. In particular, they report about the revision of the clinical diagnosis with which the girl was admitted to the OHMADYT hospital, from BA to chronic secondary obstructive bronchitis, the detection of chronic conjunctivitis with obliteration of the nasolacrimal canals, chronic sinusitis, secondary immune deficiency, keloid skin scars. Conclusions. Despite constant rehabilitation therapy and a significant improvement in the general condition of the girl, it was not possible to fully restore the function of mucociliary transport, as a result ventilation of small bronchi gradually deteriorates, bronchiectasis is observed in the basal segments of the right lung, a polyserial strain S. aureus is formed, which is constantly sown from the child's sputum; it was not possible to fully restore the patency of the nasolacrimal canals and achieve a stable remission of chronic sinusitis. The research was carried out in accordance with the principles of the Helsinki Declaration. The informed consent of the patient was obtained for conducting the studies. No conflict of interest was declared by the authors. Key words: Lyell's syndrome, children, Long-term consequences, chronic obstructive bronchitis, obesity, treatment.

Long-term consequences of Lyell's syndrome suffered in childhood

The article provides a review of literature on the long-term consequences of Lyell's syndrome (one of the forms of toxic epidermal necrolysis). Among them: chronic eczema with xerosis and itching, skin depigmentation, hypertrophic and keloid scars, nail lesions, eyes, including dry eye syndrome and chronic conjunctivitis with/without obliteration of the nasolacrimal canal, kidney disease, lung disease, Sjogren's syndrome, Hashimoto's thyroiditis and others. Clinical case. The authors present their clinical case of an 11-year-old girl who suffered from Lyell's syndrome at the age of 8 and has been observed for the past three years, share their clinical and laboratory-instrumental observations and treatment strategies. In particular, they report about the revision of the clinical diagnosis with which the girl was admitted to the OHMADYT hospital, from BA to chronic secondary obstructive bronchitis, the detection of chronic conjunctivitis with obliteration of the nasolacrimal canals, chronic sinusitis, secondary immune deficiency, keloid skin scars. Conclusions. Despite constant rehabilitation therapy and a significant improvement in the general condition of the girl, it was not possible to fully restore the function of mucociliary transport, as a result ventilation of small bronchi gradually deteriorates, bronchiectasis is observed in the basal segments of the right lung, a polyserial strain S. aureus is formed, which is constantly sown from the child's sputum; it was not possible to fully restore the patency of the nasolacrimal canals and achieve a stable remission of chronic sinusitis. The research was carried out in accordance with the principles of the Helsinki Declaration. The informed consent of the patient was obtained for conducting the studies. No conflict of interest was declared by the authors. Key words: Lyell's syndrome, children, Long-term consequences, chronic obstructive bronchitis, obesity, treatment.

Chlamydia trachomatis Mimicking COVID-19 Chronic Follicular Conjunctivitis

Purpose. To characterize the clinical presentation and report lab findings of Chlamydia trachomatis follicular conjunctivitis in two patients with a positive history of active COVID-19 infection. Participants. Two patients with follicular conjunctivitis with a recent history of COVID-19 infection. Design. Retrospective, noncomparative, case report. Methods. Demographic data including age, gender, and place of residence were recorded. A full exam with an emphasis on inflammatory characteristics and systematic workup. Sample follicles were surgically excised in selected cases, and molecular and histopathological analyses were performed. Results. Both patients were initially treated for viral conjunctivitis. After symptoms failed to resolve, biopsy results indicated that both patients were positive for chlamydia conjunctivitis and treated accordingly. Conclusions. These cases illustrate the role of biopsy as an investigative tool in chronic conjunctivitis and the importance of having a broad differential when treating patients with acute conjunctivitis.

Ophthalmological changes in patients with COVID-19 associated pneumonia

Definition of COVID-19 (CoronaVirusDesease 2019) is a severe acute respiratory infection caused by the SARS-CoV-2 virus (severe acute respiratory syndrome coronavirus 2). On March 11, 2020, WHO announced the beginning of the COVID-19 pandemic. According to Rospotrebnadzor in Russia, the disease is asymptomatic in 23% of patients, 63% have manifestations of acute upper respiratory tract infection, and 14% pneumonia occurs. The average mortality rate in the world is about 3%. The first cases of the disease were reported in Wuhan (Hubei province, in the southeast of China) in December 2019.Despite the measures taken to prevent the spread of the new infection, in February the epidemic covered many countries, including Italy, South Korea, Iran, and in March it turned into a pandemic. Objective: to identify ophthalmological changes in patients who have had COVID-19 associated pneumonia. Materials and methods: 153 patients over 18 years of age with a confirmed diagnosis of COVID-19 associated pneumonia were examined 3 months after discharge from the hospital. Results and discussion: 7.84% – chronic blepharitis, 5.88% – chronic conjunctivitis, 60.0% – dry eye syndrome, 5.8% – degenerative conjunctival changes (5.88%) and 100% changes in conjunctival hemodynamics characteristic of hypercoagulation syndrome. Conclusions: in all cases of observation, a violation of hemodynamic changes in the conjunctiva was detected.

Modern opportunities for the prevention and treatment of inflammatory eye diseases of an infectious nature in children

The development of inflammatory diseases of the cornea and conjunctiva, as well as the occurrence of infectious complications of intraocular surgery, are largely associated with the presence of saprophytic and pathogenic microflora in the conjunctival cavity. This circumstance is more characteristic of children. At the same time, the possibilities of antibacterial therapy of inflammatory eye diseases of bacterial and chlamydial etiology, as well as perioperative prophylaxis of infectious complications of intraocular surgical procedures in children, have significantly expanded today. The widespread use of fluoroquinolones has significantly improved the treatment of children with acute and chronic bacterial conjunctivitis, keratitis, blepharitis, meibomyitis, chalazion, as well as those with chronic conjunctivitis of chlamydial etiology. At the same time, levofloxacin fluoroquinolone of the 3rd generation, which is used in our country in the form of a 0.5% solution as eye drops Oftaquix (Santen, Finland), has demonstrated high efficacy for this purpose. The widespread introduction of the original 0.5% levofloxacin (Oftaquix), in the treatment regimen for children with inflammatory diseases of the cornea and conjunctiva, as well as for a perioperative prevention of infectious complications of surgical procedures involving them, is a promising way to solve the problem.