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Stawowski AR, Konopińska J, Stawowski SS, Adamczuk J, Groth M, Moniuszko-Malinowska A, Czupryna P. The Review of Ophthalmic Symptoms in COVID-19. Clin Ophthalmol 2024; 18:1417-1432. [PMID: 38803556 PMCID: PMC11129748 DOI: 10.2147/opth.s460224] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2024] [Accepted: 04/22/2024] [Indexed: 05/29/2024] Open
Abstract
The COVID-19 pandemic caused by SARS-CoV-2 had a significant impact on the health of the global human population, affecting almost every human organ, including the organ of vision. Research focus on understanding the pathophysiology, identifying symptoms and complications of the disease. Eye-related pathologies are important foci of research due to the potential for direct impact of the virus. Ophthalmologists around the world are reporting various symptoms of eye infections and ocular pathologies associated with SARS-CoV-2. The review of ophthalmic symptoms was conducted to help physicians of various specialties recognize possible ophthalmic manifestations of this viral disease. A literature review was conducted from January 2020 to July 2023 in the PubMed, MEDLINE, Science Direct, Scopus, Scielo and Google Scholar databases. The review of the literature showed that conjunctivitis is the most common ophthalmic symptom observed during the course of COVID-19 and can occur at any stage of the disease. Changes in the eye may result from the direct effect of the virus, immune response, prothrombotic states, comorbidities, and medications used. Symptoms related to the organ of vision can be divided into: changes affecting the protective apparatus of the eye, the anterior eye segment, the posterior eye segment, neuro-ophthalmic, and orbital changes. Ocular symptoms may suggest COVID-19 infection or appear several weeks after recovery. Following COVID-19 vaccinations, a diverse range of ophthalmic symptoms was observed in various locations and at different times, mirroring the ocular symptoms experienced throughout the course of the COVID-19 illness. It is important for physicians of all specialties to be aware of possible potential connections between eye diseases and SARS-CoV-2, in order to effectively diagnose and treat patients.
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Affiliation(s)
| | - Joanna Konopińska
- Department of Ophthalmology, Medical University of Bialystok, Bialystok, Poland
| | | | - Justyna Adamczuk
- Department of Infectious Diseases and Neuroinfectious, Medical University of Bialystok, Bialystok, Poland
| | - Monika Groth
- Department of Allergology and Internal Diseases, University Clinical Hospital in Bialystok, Bialystok, Poland
| | - Anna Moniuszko-Malinowska
- Department of Infectious Diseases and Neuroinfectious, Medical University of Bialystok, Bialystok, Poland
| | - Piotr Czupryna
- Department of Infectious Diseases and Neuroinfectious, Medical University of Bialystok, Bialystok, Poland
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SeyedAlinaghi S, Mehraeen E, Afzalian A, Dashti M, Ghasemzadeh A, Pashaei A, Masoud Afsahi A, Saeed Tamehri Zadeh S, Amiri Fard I, Vafaee A, Molla A, Shahidi R, Dadjou A, Amin Habibi M, Mirzapour P, Dadras O. Ocular manifestations of COVID-19: A systematic review of current evidence. Prev Med Rep 2024; 38:102608. [PMID: 38375172 PMCID: PMC10874879 DOI: 10.1016/j.pmedr.2024.102608] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2023] [Revised: 01/09/2024] [Accepted: 01/10/2024] [Indexed: 02/21/2024] Open
Abstract
Introduction COVID-19 caused by SARS-CoV-2, commonly presents with symptoms such as fever and shortness of breath but can also affect other organs. There is growing evidence pointing to potential eye complications. In this article, we aim to systematically review the ocular manifestations of COVID-19. Methods We conducted a systematic review to explore the ocular manifestations of COVID-19. We searched online databases including PubMed, Embase, Scopus, and Web of Science up to September 4, 2023. After a two-stage screening process and applying inclusion/exclusion criteria, eligible articles were advanced to the data extraction phase. The PRISMA checklist and Newcastle-Ottawa Scale (NOS) were used for quality and bias risk assessments. Results We selected and extracted data from 42 articles. Most of the studies were cross-sectional (n = 33), with the highest number conducted in Turkey (n = 10). The most frequent ocular manifestation was conjunctivitis, reported in 24 articles, followed by photophobia, burning, chemosis, itching, and ocular pain. Most studies reported complete recovery from these manifestations; however, one study mentioned visual loss in two patients. Conclusion In general, ocular manifestations of COVID-19 appear to resolve either spontaneously or with supportive treatments. For more severe cases, both medical treatment and surgery have been employed, with the outcomes suggesting that complete recoveries are attainable.
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Affiliation(s)
- SeyedAhmad SeyedAlinaghi
- Iranian Research Center for HIV/AIDS, Iranian Institute for Reduction of High Risk Behaviors, Tehran University of Medical Sciences, Tehran, Iran
| | - Esmaeil Mehraeen
- Department of Health Information Technology, Khalkhal University of Medical Sciences, Khalkhal, Iran
| | - Arian Afzalian
- School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Mohsen Dashti
- Department of Radiology, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Afsaneh Ghasemzadeh
- Department of Radiology, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Ava Pashaei
- Iranian Research Center for HIV/AIDS, Iranian Institute for Reduction of High Risk Behaviors, Tehran University of Medical Sciences, Tehran, Iran
- School of Nursing, University of British Columbia, Vancouver, British Columbia, Canada
| | - Amir Masoud Afsahi
- Department of Radiology, School of Medicine, University of California, San Diego (UCSD), CA, USA
| | - Seyed Saeed Tamehri Zadeh
- Iranian Research Center for HIV/AIDS, Iranian Institute for Reduction of High Risk Behaviors, Tehran University of Medical Sciences, Tehran, Iran
| | - Iman Amiri Fard
- MSc Student in Geriatric Nursing, Department of Community Health Nursing and Geriatric Nursing, School of Nursing and Midwifery, Iran University of Medical Sciences, Tehran, Iran
| | | | - Ayoob Molla
- School of Medicine, Bushehr University of Medical Sciences, Bushehr, Iran
| | - Ramin Shahidi
- School of Medicine, Bushehr University of Medical Sciences, Bushehr, Iran
| | - Ali Dadjou
- School of Medicine, Bushehr University of Medical Sciences, Bushehr, Iran
| | - Mohammad Amin Habibi
- Clinical Research Development Center, Qom University of Medical Sciences, Qom, Iran
| | - Pegah Mirzapour
- Iranian Research Center for HIV/AIDS, Iranian Institute for Reduction of High Risk Behaviors, Tehran University of Medical Sciences, Tehran, Iran
| | - Omid Dadras
- Department of Global Public Health and Primary Care, University of Bergen, Norway
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3
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Ahmad F, Deshmukh N, Webel A, Johnson S, Suleiman A, Mohan RR, Fraunfelder F, Singh PK. Viral infections and pathogenesis of glaucoma: a comprehensive review. Clin Microbiol Rev 2023; 36:e0005723. [PMID: 37966199 PMCID: PMC10870729 DOI: 10.1128/cmr.00057-23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2023] Open
Abstract
Glaucoma is a leading cause of irreversible blindness worldwide, caused by the gradual degeneration of retinal ganglion cells and their axons. While glaucoma is primarily considered a genetic and age-related disease, some inflammatory conditions, such as uveitis and viral-induced anterior segment inflammation, cause secondary or uveitic glaucoma. Viruses are predominant ocular pathogens and can impose both acute and chronic pathological insults to the human eye. Many viruses, including herpes simplex virus, varicella-zoster virus, cytomegalovirus, rubella virus, dengue virus, chikungunya virus, Ebola virus, and, more recently, Zika virus (ZIKV) and severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2), have been associated with sequela of either primary or secondary glaucoma. Epidemiological and clinical studies suggest the association between these viruses and subsequent glaucoma development. Despite this, the ocular manifestation and sequela of viral infections are not well understood. In fact, the association of viruses with glaucoma is considered relatively uncommon in part due to underreporting and/or lack of long-term follow-up studies. In recent years, literature on the pathological spectrum of emerging viral infections, such as ZIKV and SARS-CoV-2, has strengthened this proposition and renewed research activity in this area. Clinical studies from endemic regions as well as laboratory and preclinical investigations demonstrate a strong link between an infectious trigger and development of glaucomatous pathology. In this article, we review the current understanding of the field with a particular focus on viruses and their association with the pathogenesis of glaucoma.
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Affiliation(s)
- Faraz Ahmad
- Department of Ophthalmology, Mason Eye Institute, University of Missouri School of Medicine, Columbia, Missouri, USA
| | - Nikhil Deshmukh
- Department of Ophthalmology, Mason Eye Institute, University of Missouri School of Medicine, Columbia, Missouri, USA
| | - Aaron Webel
- Department of Ophthalmology, Mason Eye Institute, University of Missouri School of Medicine, Columbia, Missouri, USA
| | - Sandra Johnson
- Department of Ophthalmology, Mason Eye Institute, University of Missouri School of Medicine, Columbia, Missouri, USA
| | - Ayman Suleiman
- Department of Ophthalmology, Mason Eye Institute, University of Missouri School of Medicine, Columbia, Missouri, USA
| | - Rajiv R. Mohan
- Department of Ophthalmology, Mason Eye Institute, University of Missouri School of Medicine, Columbia, Missouri, USA
- Harry S. Truman Memorial Veterans' Hospital, Columbia, Missouri, USA
- Departments of Veterinary Medicine & Surgery and Biomedical Sciences, College of Veterinary Medicine, University of Missouri, Columbia, Missouri, USA
| | - Frederick Fraunfelder
- Department of Ophthalmology, Mason Eye Institute, University of Missouri School of Medicine, Columbia, Missouri, USA
| | - Pawan Kumar Singh
- Department of Ophthalmology, Mason Eye Institute, University of Missouri School of Medicine, Columbia, Missouri, USA
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4
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Salvetat ML, Musa M, Pellegrini F, Salati C, Spadea L, Zeppieri M. Considerations of COVID-19 in Ophthalmology. Microorganisms 2023; 11:2220. [PMID: 37764064 PMCID: PMC10538084 DOI: 10.3390/microorganisms11092220] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2023] [Revised: 08/30/2023] [Accepted: 08/30/2023] [Indexed: 09/15/2023] Open
Abstract
Since its emergence in early 2020, the SARS-CoV-2 infection has had a significant impact on the entire eye care system. Ophthalmologists have been categorized as a high-risk group for contracting the virus due to the belief that the eye may be a site of inoculation and transmission of the SARS-CoV-2 infection. As a result, clinical ophthalmologists, optometrists, and eyecare professionals have had to familiarize themselves with the ocular manifestations of COVID-19, as well as its treatments and vaccines. The implementation of measures to prevent the transmission of the virus, such as restrictions, lockdowns, telemedicine, and artificial intelligence (AI), have led to substantial and potentially irreversible changes in routine clinical practice, education, and research. This has resulted in the emergence of a new mode of managing patients in a routine clinical setting. This brief review aims to provide an overview of various aspects of COVID-19 in ophthalmology, including the ocular manifestations related to the disease, the modes of transmission of SARS-CoV-2 infection, precautions taken in ophthalmic practice to prevent the spread of the virus, drugs, and vaccines used in the treatment of COVID-19, the impact of the pandemic on patients, clinicians, and the eye care system as a whole, and the future of ophthalmology conditioned by this global pandemic experience.
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Affiliation(s)
- Maria Letizia Salvetat
- Department of Ophthalmology, Azienda Sanitaria Friuli Occidentale, 33170 Pordenone, Italy
| | - Mutali Musa
- Department of Optometry, University of Benin, Benin City 300238, Edo State, Nigeria
| | - Francesco Pellegrini
- Department of Ophthalmology, Azienda Sanitaria Friuli Occidentale, 33170 Pordenone, Italy
| | - Carlo Salati
- Department of Ophthalmology, University Hospital of Udine, 33100 Udine, Italy
| | - Leopoldo Spadea
- Eye Clinic, Policlinico Umberto I, “Sapienza” University of Rome, 00142 Rome, Italy
| | - Marco Zeppieri
- Department of Ophthalmology, University Hospital of Udine, 33100 Udine, Italy
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5
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Gallenga CE, Maritati M, Mura M, Di Virgilio F, Conti P, Contini C. Macrophage Activation in Follicular Conjunctivitis during the COVID-19 Pandemic. Microorganisms 2023; 11:2198. [PMID: 37764042 PMCID: PMC10534302 DOI: 10.3390/microorganisms11092198] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2023] [Revised: 08/12/2023] [Accepted: 08/28/2023] [Indexed: 09/29/2023] Open
Abstract
Among the symptoms of SARS-CoV-2, follicular conjunctivitis has become relevant. The conjunctiva acts as an open lymph node, reacting to the viral antigen that binds the epithelial cells, forming follicles of B cells with activated T cells and NK cells on its surface, which, in turn, talk to monocyte-derived inflammatory infected macrophages. Here, the NLRP3 inflammasome is a major driver in releasing pro-inflammatory factors such as IL-6 and caspase-1, leading to follicular conjunctivitis and bulbar congestion, even as isolated signs in the 'asymptomatic' patient.
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Affiliation(s)
- Carla Enrica Gallenga
- Department of Medical Sciences Doctoral Course Molecular Medicine, University of Ferrara, 44121 Ferrara, Italy;
- Ophthalmology Unit, University—Hospital Cona, 44124 Ferrara, Italy;
| | - Martina Maritati
- Bone and Infections Lab, Santa Maria Maddalena NH, Occhiobello, 45030 Rovigo, Italy; mrtmtn#@unife.it
- Department of Medical Sciences, Infectious Diseases Unit, University of Ferrara, 44121 Ferrara, Italy
| | - Marco Mura
- Ophthalmology Unit, University—Hospital Cona, 44124 Ferrara, Italy;
- Department of Translational Medicine and for the Romagna, Ophthalmology, University of Ferrara, 44121 Ferrara, Italy
| | - Francesco Di Virgilio
- Department of Medical Sciences Doctoral Course Molecular Medicine, University of Ferrara, 44121 Ferrara, Italy;
- Department of Medical Sciences, University of Ferrara, 44121 Ferrara, Italy
| | - Pio Conti
- School of Medicine, Immunology, G. D’Annunzio University, Chieti-Pescara, 66100 Chieti, Italy;
- Molecular Pharmacology and Drug Discovery Laboratory, School of Medicine, Tufts University, Boston, MA 02111, USA
| | - Carlo Contini
- Department of Medical Sciences, Section Dermatology and Infectious Diseases, University of Ferrara, 44124 Ferrara, Italy;
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6
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Beikzadeh S, Akbarinejad A, Taylor J, Perera J, Ross J, Swift S, Kilmartin PA, Travas-Sejdic J. From energy storage to pathogen eradication: unveiling the antibacterial and antiviral capacities of flexible solid-state carbon cloth supercapacitors. J Mater Chem B 2023; 11:8170-8181. [PMID: 37401360 DOI: 10.1039/d3tb01085f] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/05/2023]
Abstract
With the emergence of deadly viral and bacterial infections, preventing the spread of microorganisms on surfaces has gained ever-increasing importance. This study investigates the potential of solid-state supercapacitors as antibacterial and antiviral devices. We developed a low-cost and flexible carbon cloth supercapacitor (CCSC) with highly efficient antibacterial and antiviral surface properties. The CCSC comprised two parallel layers of carbon cloth (CC) electrodes assembled in a symmetric, electrical double-layer supercapacitor structure that can be charged at low potentials between 1 to 2 V. The optimized CCSC exhibited a capacitance of 4.15 ± 0.3 mF cm-2 at a scan rate of 100 mV s-1, high-rate capability (83% retention of capacitance at 100 mV s-1 compared to its value at 5 mV s-1), and excellent electrochemical stability (97% retention of the initial capacitance after 1000 cycles). Moreover, the CCSC demonstrated outstanding flexibility and retained its full capacitance even when bent at high angles, making it suitable for wearable or flexible devices. Using its stored electrical charge, the charged CCSC disinfects bacteria effectively and neutralizes viruses upon surface contact with the positive and negative electrodes. The charged CCSC device yielded a 6-log CFU reduction of Escherichia coli bacterial inocula and a 5-log PFU reduction of HSV-1 herpes virus. Antibacterial and antiviral carbon cloth supercapacitors represent a promising platform technology for various applications, including electronic textiles and electronic skins, health monitoring or motion sensors, wound dressings, personal protective equipment (e.g., masks) and air filtration systems.
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Affiliation(s)
- Sara Beikzadeh
- Centre for Innovative Materials for Health, School of Chemical Sciences, The University of Auckland, 23 Symonds Street, Auckland, 1023, New Zealand.
- MacDiarmid Institute for Advanced Materials and Nanotechnology, Kelburn Parade, Wellington, 6140, New Zealand
| | - Alireza Akbarinejad
- Centre for Innovative Materials for Health, School of Chemical Sciences, The University of Auckland, 23 Symonds Street, Auckland, 1023, New Zealand.
| | - John Taylor
- School of Biological Sciences, The University of Auckland, Auckland, New Zealand
| | - Janesha Perera
- Department of Molecular Medicine and Pathology, Faculty of Medical and Health Sciences, The University of Auckland, Private Bag 92019, Auckland 1042, New Zealand
| | - Jacqueline Ross
- Department of Anatomy and Medical Imaging, The University of Auckland, Private Bag, Auckland 92019, New Zealand
| | - Simon Swift
- Department of Molecular Medicine and Pathology, Faculty of Medical and Health Sciences, The University of Auckland, Private Bag 92019, Auckland 1042, New Zealand
| | - Paul A Kilmartin
- Centre for Innovative Materials for Health, School of Chemical Sciences, The University of Auckland, 23 Symonds Street, Auckland, 1023, New Zealand.
| | - Jadranka Travas-Sejdic
- Centre for Innovative Materials for Health, School of Chemical Sciences, The University of Auckland, 23 Symonds Street, Auckland, 1023, New Zealand.
- MacDiarmid Institute for Advanced Materials and Nanotechnology, Kelburn Parade, Wellington, 6140, New Zealand
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7
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Ding Q, Zhao H. Long-term effects of SARS-CoV-2 infection on human brain and memory. Cell Death Discov 2023; 9:196. [PMID: 37380640 DOI: 10.1038/s41420-023-01512-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2023] [Revised: 06/05/2023] [Accepted: 06/20/2023] [Indexed: 06/30/2023] Open
Abstract
The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) variants have caused several waves of outbreaks. From the ancestral strain to Omicron variant, SARS-CoV-2 has evolved with the high transmissibility and increased immune escape against vaccines. Because of the multiple basic amino acids in the S1-S2 junction of spike protein, the widespread distribution of angiotensin-converting enzyme 2 (ACE2) receptor in human body and the high transmissibility, SARS-CoV-2 can infect multiple organs and has led to over 0.7 billion infectious cases. Studies showed that SARS-CoV-2 infection can cause more than 10% patients with the Long-COVID syndrome, including pathological changes in brains. This review mainly provides the molecular foundations for understanding the mechanism of SARS-CoV-2 invading human brain and the molecular basis of SARS-CoV-2 infection interfering with human brain and memory, which are associated with the immune dysfunction, syncytia-induced cell death, the persistence of SARS-CoV-2 infection, microclots and biopsychosocial aspects. We also discuss the strategies for reducing the Long-COVID syndrome. Further studies and analysis of shared researches will allow for further clarity regarding the long-term health consequences.
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Affiliation(s)
- Qiulu Ding
- School of Finance and Business, Shanghai Normal University, Shanghai, China
- School of Education, Shanghai Normal University, Shanghai, China
| | - HanJun Zhao
- Department of Microbiology, School of Clinical Medicine, LKS Faculty of Medicine, The University of Hong Kong, Pokfulam, Hong Kong Special Administrative Region, China.
- Centre for Virology, Vaccinology and Therapeutics, Science Park, Hong Kong Special Administrative Region, China.
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8
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Eyfferth T, Koczulla AR, Freytag HW, Krahl G, Ackermann C, Bultmann S, Reimertz R, Dresing K. [The problem of long/post-COVID in expert assessments]. UNFALLCHIRURGIE (HEIDELBERG, GERMANY) 2023; 126:373-386. [PMID: 37079057 PMCID: PMC10117274 DOI: 10.1007/s00113-023-01297-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 01/16/2023] [Indexed: 04/21/2023]
Abstract
Assessing long/post-COVID syndrome (PCS) following an infection with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is a multidisciplinary challenge due to the diverse and complex symptoms. Besides discipline-specific evaluation of infection-related organ damage, the main issue is expert objectivity and causality assessment regarding subjective symptoms. The consequences of long/PCS raise questions of insurance rights in all fields of law. In cases of persistent impairment of performance, determining reduction in earning capacity is crucial for those affected. Recognition as an occupational disease (BK no. 3101) is vital for employees in healthcare and welfare sectors, along with occupational accident recognition and assessing the illness's consequences, including the reduction in earning capacity (MdE) in other sectors or work areas. Therefore, expert assessments of illness consequences and differentiation from previous illnesses or damage disposition are necessary in all areas of law, individually based on corresponding organ manifestations in medical fields and interdisciplinarily for complex late sequelae, for instance, by internists with appropriate qualifications for pulmonary or cardiac manifestations and neurologists, psychiatrists, and neuropsychologists for neurological and psychiatric manifestations, etc.
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Affiliation(s)
- T Eyfferth
- BG Service- und Rehabilitationszentrum, BG Unfallklinik Frankfurt am Main gGmbH, Akademisches Lehrkrankenhaus, Johann-Wolfgang-Goethe Universität Frankfurt Main, Friedberger Landstr. 430, 60389, Frankfurt am Main, Deutschland.
- Sektion Begutachtung der Deutschen Gesellschaft für Orthopädie und Unfallchirurgie (DGOU), Berlin, Deutschland.
| | - A R Koczulla
- Schön Klinik Berchtesgadener Land, Schönau am Königssee, Deutschland
- Professur für Pneumologische Rehabilitation Philipps Universität Marburg, Deutsches Zentrum für Lungenforschung, Marburg, Deutschland
| | - H W Freytag
- Psychotraumatologie (PZDT), BG Unfallklinik Frankfurt am Main, Frankfurt am Main, Deutschland
| | - G Krahl
- Psychotraumatologie (PZDT), BG Unfallklinik Frankfurt am Main, Frankfurt am Main, Deutschland
| | - Ch Ackermann
- Psychotraumatologie (PZDT), BG Unfallklinik Frankfurt am Main, Frankfurt am Main, Deutschland
| | - S Bultmann
- Sozialgericht Hamburg, Hamburg, Deutschland
| | - R Reimertz
- BG Service- und Rehabilitationszentrum, BG Unfallklinik Frankfurt am Main gGmbH, Akademisches Lehrkrankenhaus, Johann-Wolfgang-Goethe Universität Frankfurt Main, Friedberger Landstr. 430, 60389, Frankfurt am Main, Deutschland
| | - K Dresing
- Klinik für Unfallchirurgie, Orthopädie und Plastische Chirurgie, Universitätsmedizin Göttingen, Göttingen, Deutschland
- Sektion Begutachtung der Deutschen Gesellschaft für Orthopädie und Unfallchirurgie (DGOU), Berlin, Deutschland
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9
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AlGhawi FS, AlMudarra SS, Assiri AM. Mortality patterns among COVID‐19 patients in two Saudi hospitals: Demographics, etiology, and treatment. Influenza Other Respir Viruses 2023; 17:e13127. [PMID: 36970568 PMCID: PMC10030359 DOI: 10.1111/irv.13127] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2022] [Revised: 02/26/2023] [Accepted: 03/02/2023] [Indexed: 03/24/2023] Open
Abstract
Background Saudi Arabia (SA) reported its first case of COVID‐19 on 2 March 2020. Mortality varied nationwide; by April 14, 2020, Medina had 16% of SA's total COVID‐19 cases and 40% of all COVID‐19 deaths. A team of epidemiologists investigated to identify factors impacting survival. Methods We reviewed medical records from two hospitals: Hospital A in Medina and Hospital B in Dammam. All patients with a registered COVID‐related death between March and May 1, 2020, were included. We collected data on demographics, chronic health conditions, clinical presentation, and treatment. We analyzed data using SPSS. Results We identified 76 cases: 38 cases from each hospital. More fatalities were among non‐Saudis at Hospital A (89%) versus Hospital B (82%, p < 0.001). Hypertension prevalence was higher among cases at Hospital B (42%) versus Hospital A (21%) (p < 0.05). We found statistically significant differences (p < 0.05) in symptoms at initial presentation among cases at Hospital B versus Hospital A, including body temperature (38°C vs. 37°C), heart rate (104 bpm vs. 89 bpm), and regular breathing rhythms (61% vs. 55%). Fewer cases (50%) at Hospital A received heparin versus Hospital B (97%, p‐value < 0.001). Conclusion Patients who died typically presented with more severe illnesses and were more likely to have underlying health conditions. Migrant workers may be at increased risk due to poorer baseline health and reluctance to seek care. This highlights the importance of cross‐cultural outreach to prevent deaths. Health education efforts should be multilingual and accommodate all literacy levels.
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Affiliation(s)
| | - Sami S. AlMudarra
- Field Epidemiology Training ProgramMinistry of HealthRiyadhSaudi Arabia
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10
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McHarg M, Wang Y, Yakin M, Zeleny A, Caplash S, Sen HN, Kodati S. Ocular symptoms in COVID-19 infection: a survey study. J Ophthalmic Inflamm Infect 2022; 12:42. [PMID: 36538113 PMCID: PMC9765365 DOI: 10.1186/s12348-022-00319-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2022] [Accepted: 11/28/2022] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Coronavirus disease 2019 (COVID-19) systemic symptoms and sequelae have been studied extensively, but less is known about the characterization, duration, and long-term sequelae of ocular symptoms associated with COVID-19 infection. The purpose of this study was to analyze the frequency, spectrum, and duration of ocular symptoms in participants with COVID-19 infection treated in inpatient and outpatient settings. METHODS A retrospective electronic survey was distributed to NIH employees and the public who reported testing positive for SARS-CoV-2. The anonymous survey collected information on demographics, past ocular history, systemic COVID-19 symptoms, and ocular symptoms. RESULTS A total of 229 (21.9% male and 78.1% female, mean age 42.5 ± 13.9) survey responses were included. Ocular symptoms were reported by 165 participants with a mean of 2.31 ± 2.42 symptoms. The most commonly reported ocular symptoms were light sensitivity (31.0%), itchy eyes (24.9%), tearing (24.9%), eye redness (24.5%), and eye pain (24.5%). Participants with ocular symptoms had a higher number of systemic symptoms compared to participants without ocular symptoms (mean 9.17 ± 4.19 vs 6.22 ± 3.63; OR: 1.21; 95% CI: 1.11 - 1.32; p < 0.001). Ocular symptoms were more common in those who reported a past ocular history compared to those who did not (81.8% vs 67.1%; OR: 2.17; 95% CI: 1.08 - 4.37; p = 0.03). Additionally, the onset of ocular symptoms occurred most frequently at the same time as systemic symptoms (47.5%), and 21.8% reported symptoms lasting ≥ 14 days. CONCLUSIONS Ocular surface-related symptoms are the most frequent ocular manifestations, and systemic disease severity is associated with the presence of ocular symptoms. Additionally, our results show that ocular symptoms can persist post-COVID-19 infection. Further work is needed to better understand ocular symptoms in COVID-19 and long-term sequelae.
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Affiliation(s)
- Matthew McHarg
- grid.280030.90000 0001 2150 6316National Eye Institute, National Institutes of Health, 10 Centre Drive, 10/10N248, Bethesda, MD USA ,grid.253615.60000 0004 1936 9510George Washington University School of Medicine and Health Sciences, Washington, DC USA
| | - Yujuan Wang
- grid.280030.90000 0001 2150 6316National Eye Institute, National Institutes of Health, 10 Centre Drive, 10/10N248, Bethesda, MD USA
| | - Mehmet Yakin
- grid.280030.90000 0001 2150 6316National Eye Institute, National Institutes of Health, 10 Centre Drive, 10/10N248, Bethesda, MD USA ,grid.413783.a0000 0004 0642 6432Department of Ophthalmology, University of Health Sciences, Ankara Training and Research Hospital, Ankara, Turkey
| | - Alex Zeleny
- grid.280030.90000 0001 2150 6316National Eye Institute, National Institutes of Health, 10 Centre Drive, 10/10N248, Bethesda, MD USA ,grid.213910.80000 0001 1955 1644Georgetown University School of Medicine, Washington, DC USA
| | - Sonny Caplash
- grid.412689.00000 0001 0650 7433Department of Ophthalmology, University of Pittsburgh Medical Center, Pittsburgh, PA USA
| | - H Nida Sen
- grid.280030.90000 0001 2150 6316National Eye Institute, National Institutes of Health, 10 Centre Drive, 10/10N248, Bethesda, MD USA
| | - Shilpa Kodati
- grid.280030.90000 0001 2150 6316National Eye Institute, National Institutes of Health, 10 Centre Drive, 10/10N248, Bethesda, MD USA
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11
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Kurysheva NI, Pererva OA, Nikitina AD. Eye damage in COVID-19. Part 1: Involvement of the eye in SARS-CoV-2 virus transmission and anterior segment complications. RUSSIAN OPHTHALMOLOGICAL JOURNAL 2022. [DOI: 10.21516/2072-0076-2022-15-4-156-165] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
In COVID-19, eye damage may develop at any stage of the disease. Viral ribonucleic acid has been found in ocular tissues, but the role of the eye as a route of infection is yet to be substantiated. Ophthalmic manifestations may be a typical feature of COVID-19 infection or they may develop several weeks after recovery. Ophthalmologists should be aware of possible relationships of an ophthalmic pathology with SARS-CoV-2 in order to obtain targeted case history, detect the specific signs, prescribe the necessary tests and thereby reduce the spread of the infection. These relationships are also important for early diagnosis and treatment of complications that threaten the patients’ life and vision. The first part of the review focuses on the possible involvement of the eye in SARS-CoV-2 infection and the spread of infection. Clinical manifestations of the anterior segment damage are considered.
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Affiliation(s)
- N. I. Kurysheva
- Medical Biological University of Innovations and Continuing Education — A.I. Burnazyan Medical Biophysical Center; Ophthalmological Center, Federal Medical and Biological Agency
| | - O. A. Pererva
- Medical Biological University of Innovations and Continuing Education — A.I. Burnazyan Medical Biophysical Center; Ophthalmological Center, Federal Medical and Biological Agency
| | - A. D. Nikitina
- Medical Biological University of Innovations and Continuing Education — A.I. Burnazyan Medical Biophysical Center; Ophthalmological Center, Federal Medical and Biological Agency
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12
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Abstract
The German Society of Pneumology initiated 2021 the AWMF S1 guideline Long COVID/Post-COVID. In a broad interdisciplinary approach, this S1 guideline was designed based on the current state of knowledge.The clinical recommendations describe current Long COVID/Post-COVID symptoms, diagnostic approaches, and therapies.In addition to the general and consensus introduction, a subject-specific approach was taken to summarize the current state of knowledge.The guideline has an explicit practical claim and will be developed and adapted by the author team based on the current increase in knowledge.
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13
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Executive summary: Japanese guidelines for allergic conjunctival diseases 2021. Allergol Int 2022; 71:459-471. [PMID: 36096976 DOI: 10.1016/j.alit.2022.07.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2022] [Accepted: 07/14/2022] [Indexed: 11/23/2022] Open
Abstract
Allergic conjunctival disease (ACD) is an inflammatory disease of the conjunctiva that is mainly caused by type I hypersensitivity response to allergens and accompanied by subjective symptoms and other findings induced by antigens. ACD is classified as allergic conjunctivitis, atopic keratoconjunctivitis, vernal keratoconjunctivitis, and giant papillary conjunctivitis. This article summarizes the third edition of the Japanese guidelines for allergic conjunctival diseases published in 2021 and outlines the diagnosis, pathogenesis, and treatment of ACD. Since the introduction of immunosuppressive eye drops, the treatment strategies for severe ACDs have significantly changed. To clarify the recommended standard treatment protocols for ACD, the advantages and disadvantages of these treatments were assessed using clinical questions, with a focus on the use of steroids and immunosuppressive drugs. This knowledge will assist healthcare providers and patients in taking an active role in medical decision making.
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14
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Hall S, Johnson P, Bailey C, Gould Z, White R, Crook B. Evaluation of Face Shields, Goggles, and Safety Glasses as a Virus Transmission Control Measure to Protect the Wearer Against Cough Droplets. Ann Work Expo Health 2022; 67:36-49. [PMID: 35853621 PMCID: PMC9384474 DOI: 10.1093/annweh/wxac047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2022] [Revised: 04/08/2022] [Accepted: 06/23/2022] [Indexed: 01/14/2023] Open
Abstract
Face shields (also referred to as visors), goggles and safety glasses have been worn during the COVID-19 pandemic as one measure to control transmission of the virus. However, their effectiveness in controlling facial exposure to cough droplets is not well established and standard tests for evaluating eye protection for this application are limited. A method was developed to evaluate face shields, goggles, and safety glasses as a control measure to protect the wearer against cough droplets. The method uses a semi-quantitative assessment of facial droplet deposition. A cough simulator was developed to generate droplets comparable to those from a human cough. The droplets consisted of a UV fluorescent marker (fluorescein) in water. Fourteen face shields, four pairs of goggles and one pair of safety glasses were evaluated by mounting them on two different sizes of breathing manikin head and challenging them with the simulated cough. The manikin head was positioned in seven orientations relative to the cough simulator to represent various potential occupational exposure scenarios, for example, a nurse standing over a patient. Droplet deposition in the eyes, nose and mouth regions were visualised following three 'coughs'. Face shields, goggles, and safety glasses reduced, but did not eliminate exposure to the wearer from droplets such as those produced by a human cough. The level of protection differed based on the design of the personal protective equipment and the relative orientation of the wearer to the cough. For example, face shields, and goggles offered the greatest protection when a cough challenge was face on or from above and the least protection when a cough challenge was from below. Face shields were also evaluated as source control to protect others from the wearer. Results suggested that if a coughing person wears a face shield, it can provide some protection from cough droplets to those standing directly in front of the wearer.
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Affiliation(s)
- Samantha Hall
- Author to whom correspondence should be addressed. Tel: +44-02030282185; e-mail:
| | - Paul Johnson
- Health and Safety Executive Science and Research Centre, Harpur Hill, Buxton, Derbyshire SK17 9JN, UK
| | - Claire Bailey
- Health and Safety Executive Science and Research Centre, Harpur Hill, Buxton, Derbyshire SK17 9JN, UK
| | - Zoe Gould
- Health and Safety Executive Science and Research Centre, Harpur Hill, Buxton, Derbyshire SK17 9JN, UK
| | - Robert White
- Health and Safety Executive Science and Research Centre, Harpur Hill, Buxton, Derbyshire SK17 9JN, UK
| | - Brian Crook
- Health and Safety Executive Science and Research Centre, Harpur Hill, Buxton, Derbyshire SK17 9JN, UK
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15
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Jackson RM, Hatton CF, Spegarova JS, Georgiou M, Collin J, Stephenson E, Verdon B, Haq IJ, Hussain R, Coxhead JM, Mudhar HS, Wagner B, Hasoon M, Davey T, Rooney P, Khan CMA, Ward C, Brodlie M, Haniffa M, Hambleton S, Armstrong L, Figueiredo F, Queen R, Duncan CJA, Lako M. Conjunctival epithelial cells resist productive SARS-CoV-2 infection. Stem Cell Reports 2022; 17:1699-1713. [PMID: 35750043 PMCID: PMC9222349 DOI: 10.1016/j.stemcr.2022.05.017] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Revised: 05/23/2022] [Accepted: 05/24/2022] [Indexed: 12/01/2022] Open
Abstract
Conjunctival epithelial cells, which express viral-entry receptors angiotensin-converting enzyme 2 (ACE2) and transmembrane protease serine type 2 (TMPRSS2), constitute the largest exposed epithelium of the ocular surface tissue and may represent a relevant viral-entry route. To address this question, we generated an organotypic air-liquid-interface model of conjunctival epithelium, composed of basal, suprabasal, and superficial epithelial cells, and fibroblasts, which could be maintained successfully up to day 75 of differentiation. Using single-cell RNA sequencing (RNA-seq), with complementary imaging and virological assays, we observed that while all conjunctival cell types were permissive to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) genome expression, a productive infection did not ensue. The early innate immune response to SARS-CoV-2 infection in conjunctival cells was characterised by a robust autocrine and paracrine NF-κB activity, without activation of antiviral interferon signalling. Collectively, these data enrich our understanding of SARS-CoV-2 infection at the human ocular surface, with potential implications for the design of preventive strategies and conjunctival transplantation.
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Affiliation(s)
- Robert M Jackson
- Biosciences Institute, Newcastle University, Newcastle Upon Tyne, UK
| | - Catherine F Hatton
- Translational and Clinical Research Institute, Newcastle University, Newcastle Upon Tyne, UK
| | | | - Maria Georgiou
- Biosciences Institute, Newcastle University, Newcastle Upon Tyne, UK
| | - Joseph Collin
- Biosciences Institute, Newcastle University, Newcastle Upon Tyne, UK
| | - Emily Stephenson
- Biosciences Institute, Newcastle University, Newcastle Upon Tyne, UK
| | - Bernard Verdon
- Biosciences Institute, Newcastle University, Newcastle Upon Tyne, UK
| | - Iram J Haq
- Translational and Clinical Research Institute, Newcastle University, Newcastle Upon Tyne, UK
| | - Rafiqul Hussain
- Biosciences Institute, Newcastle University, Newcastle Upon Tyne, UK
| | | | - Hardeep-Singh Mudhar
- National Specialist Ophthalmic Pathology Service (NSOPS) Department of Histopathology, E-Floor, Royal Hallamshire Hospital, Sheffield, UK
| | - Bart Wagner
- Electron Microscopy Unit, Royal Hallamshire Hospital, Sheffield, UK
| | - Megan Hasoon
- Biosciences Institute, Newcastle University, Newcastle Upon Tyne, UK
| | - Tracey Davey
- Electron Microscopy Unit, Royal Hallamshire Hospital, Sheffield, UK
| | - Paul Rooney
- NHS Blood and Transplant Tissue and Eye Services, Liverpool, UK
| | - C M Anjam Khan
- Biosciences Institute, Newcastle University, Newcastle Upon Tyne, UK
| | - Chris Ward
- Biosciences Institute, Newcastle University, Newcastle Upon Tyne, UK
| | - Malcolm Brodlie
- Translational and Clinical Research Institute, Newcastle University, Newcastle Upon Tyne, UK
| | - Muzlifah Haniffa
- Biosciences Institute, Newcastle University, Newcastle Upon Tyne, UK; Department of Dermatology and NIHR Newcastle Biomedical Research Centre, Newcastle Hospitals NHS Foundation Trust, Newcastle Upon Tyne, UK; Wellcome Sanger Institute, Wellcome Genome Campus, Hinxton, Cambridge, UK
| | - Sophie Hambleton
- Translational and Clinical Research Institute, Newcastle University, Newcastle Upon Tyne, UK
| | - Lyle Armstrong
- Biosciences Institute, Newcastle University, Newcastle Upon Tyne, UK
| | - Francisco Figueiredo
- Biosciences Institute, Newcastle University, Newcastle Upon Tyne, UK; Department of Ophthalmology, Royal Victoria Infirmary and Newcastle University, Newcastle, UK
| | - Rachel Queen
- Biosciences Institute, Newcastle University, Newcastle Upon Tyne, UK.
| | - Christopher J A Duncan
- Translational and Clinical Research Institute, Newcastle University, Newcastle Upon Tyne, UK.
| | - Majlinda Lako
- Biosciences Institute, Newcastle University, Newcastle Upon Tyne, UK.
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16
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Baj J, Forma A, Teresińska B, Tyczyńska M, Zembala J, Januszewski J, Flieger J, Buszewicz G, Teresiński G. How Does SARS-CoV-2 Affect Our Eyes-What Have We Learnt So Far about the Ophthalmic Manifestations of COVID-19? J Clin Med 2022; 11:3379. [PMID: 35743449 PMCID: PMC9225256 DOI: 10.3390/jcm11123379] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2022] [Revised: 05/21/2022] [Accepted: 06/08/2022] [Indexed: 12/03/2022] Open
Abstract
The severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) infection has become a worldwide threat resulting in a pandemic in 2020. SARS-CoV-2 infection manifests itself as coronavirus disease 2019 (COVID-19) that is evidenced in a vast number of either specific or nonspecific symptoms. Except for typical (but nonspecific) symptoms such as fever, dry cough, or muscle weakness, the infected patients might also present atypical symptoms including neurological, dermatological, or ophthalmic manifestations. This paper summarizes the current state of knowledge regarding the onset, progression, and types of ophthalmic symptoms induced by SARS-CoV-2 infection recognized amongst the infected patients.
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Affiliation(s)
- Jacek Baj
- Chair and Department of Anatomy, Medical University of Lublin, 20-090 Lublin, Poland; (M.T.); (J.J.)
| | - Alicja Forma
- Chair and Department of Forensic Medicine, Medical University of Lublin, 20-090 Lublin, Poland; (B.T.); (G.B.); (G.T.)
| | - Barbara Teresińska
- Chair and Department of Forensic Medicine, Medical University of Lublin, 20-090 Lublin, Poland; (B.T.); (G.B.); (G.T.)
| | - Magdalena Tyczyńska
- Chair and Department of Anatomy, Medical University of Lublin, 20-090 Lublin, Poland; (M.T.); (J.J.)
| | - Julita Zembala
- Department of Ophthalmology, Medical University of Warsaw, 02-091 Warsaw, Poland;
| | - Jacek Januszewski
- Chair and Department of Anatomy, Medical University of Lublin, 20-090 Lublin, Poland; (M.T.); (J.J.)
| | - Jolanta Flieger
- Department of Analytical Chemistry, Medical University of Lublin, 20-093 Lublin, Poland;
| | - Grzegorz Buszewicz
- Chair and Department of Forensic Medicine, Medical University of Lublin, 20-090 Lublin, Poland; (B.T.); (G.B.); (G.T.)
| | - Grzegorz Teresiński
- Chair and Department of Forensic Medicine, Medical University of Lublin, 20-090 Lublin, Poland; (B.T.); (G.B.); (G.T.)
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17
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Binotti W, Hamrah P. COVID-19-related Conjunctivitis Review: Clinical Features and Management. Ocul Immunol Inflamm 2022; 31:778-784. [PMID: 35394858 DOI: 10.1080/09273948.2022.2054432] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
PURPOSE The ongoing coronavirus disease-2019 (COVID-19) pandemic has greatly impacted theworld. In this review article, we discuss the conjunctival and nasolacrimal mucosa as a potential route for the severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) transmission, its ocular manifestations, and management. METHODS Literature review was conducted in the PubMed, Google Scholar and EMBASE databases using keywords such as "coronavirus", COVID-19", "SARS-CoV-2", "conjunctivitis", "ocular surface", "eye" and "ophthalmology". RESULTS The ocular surface may serve as an entry point and reservoir for the virus. Frequency of hand-eye contact was an independent risk factor for COVID-19-related conjunctivitis. Therefore, appropriate protective eyewear or face shields are recommended, especially for health-care workers. Bilateral conjunctival sampling within 9 days of symptom onset provides a higher positive yield rate. Pooled analysis shows an incidence of 11.4% (95%CI = 6.4-17.2%) of ocular manifestations in patients with SARS-CoV-2 infection, including hospitalized and non-hospitalized patients. CONCLUSION Conjunctivitis was the most common ocular manifestation, of which ocular redness or congestion, ocular pain, and follicular conjunctivitis were the most common presentation.COVID-19-related conjunctivitis has a self-limiting disease course, and treatment should be mainly supportive.
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Affiliation(s)
- William Binotti
- Center for Translational Ocular Immunology, Tufts Medical Center, Department of Ophthalmology, Tufts University School of Medicine, Boston, Massachusetts, USA.,Cornea Service, New England Eye Center, Tufts Medical Center, Department of Ophthalmology, Tufts University School of Medicine, Boston, Massachusetts, USA
| | - Pedram Hamrah
- Center for Translational Ocular Immunology, Tufts Medical Center, Department of Ophthalmology, Tufts University School of Medicine, Boston, Massachusetts, USA.,Cornea Service, New England Eye Center, Tufts Medical Center, Department of Ophthalmology, Tufts University School of Medicine, Boston, Massachusetts, USA
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18
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Rosani U, Del Vecchio C, Franchin E, Brun P, Ferrari S, Ponzin D, Leonardi A. Tracing the SARS-CoV-2 infection on the ocular surface: Overview and preliminary corneoscleral transcriptome sequencing. Exp Eye Res 2022; 217:108975. [PMID: 35134391 PMCID: PMC8816849 DOI: 10.1016/j.exer.2022.108975] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2021] [Revised: 01/23/2022] [Accepted: 02/01/2022] [Indexed: 11/22/2022]
Abstract
COVID-19's impact on the ocular surface has already been recognized, however the molecular mechanisms induced by the infection on the ocular surface are still unclear. The aim of this paper is to provide a first overview of the transcriptional perturbations caused by SARS-CoV-2 on the ocular surface by analyzing gene expression profile of corneoscleral ring samples from post-mortem SARS-CoV-2 positive donors (PD). The presence of SARS-CoV-2 on the ocular surface, in tears and corneal tissues has rarely been detected in infected individuals in both the presence and the absence of ocular manifestations. In this preliminary study, 6 human corneoscleral tissues of 3 PD and two tissues from a negative donor (CTRL) were obtained at the local eye bank. The presence of genomic and sub-genomic SARS-CoV-2 RNAs was assessed by qRT-PCR, while transcriptome analysis (RNA-sequencing) was performed by Illumina. Principal Component Analysis (PCA), search for differentially expressed genes (DEGs) and Gene Ontology (GO)-enrichment analysis were performed. Three samples from PD were found positive for SARS-CoV-2 genomic RNA, although the absence of sub-genomic RNAs indicated an inactive virus. PCA analysis grouped 3 different clusters, one including CTRL, and the other two including, respectively, PD with undetected SARS-CoV-2 (PD-SARS-neg) and PD with detected SARS-CoV-2 (PD-SARS-pos). The DEGs in common with the 2 PD clusters included several genes associable to the interferon pathway, such as ADAMTS4, RSAD2, MMP1, IL6, ISG15 and proinflammatory cytokines. Among the down-regulated genes we found AQP5. GO analysis revealed 77 GO terms over-represented in PD-SARS-neg vs. CTRL, and 17 GO terms in PD-SARS-pos vs. CTRL. The presence of SARS-CoV-2 RNA and RNA-sequencing reads in ocular surface tissues supports the possibility that the eye acts as an entry route. The modulation of early responsive genes, together with several ISGs suggests a potential protective responsiveness of the ocular tissues to SARS-CoV-2.
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Affiliation(s)
| | | | - Elisa Franchin
- Department of Molecular Medicine, University of Padova, Italy
| | - Paola Brun
- Department of Molecular Medicine, University of Padova, Italy
| | | | - Diego Ponzin
- Fondazione Banca degli Occhi del Veneto, Venice, Italy
| | - Andrea Leonardi
- Department of Neuroscience, Ophthalmology Unit, University of Padova, Italy.
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19
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Andrade SA, Lima RE, Varotti FDP, Abdelwahab O, Lwaleed BA. COVID-19 pandemic: multilevel dental technical guidelines based on new scientific evidence. EINSTEIN-SAO PAULO 2022; 20:eAE6307. [PMID: 35293431 PMCID: PMC8909155 DOI: 10.31744/einstein_journal/2022ae6307] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2020] [Accepted: 12/17/2020] [Indexed: 11/06/2022] Open
Abstract
The COVID-19 pandemic imposed restrictive measures on dentistry in different regions of the world, ranging from stoppage of care to only permission for urgent and emergency dental services. Thus, new biosafety guidelines for resuming activities, whether in single dental offices, large clinics or dental education activities, are urgently required. In this sense, herein, guidelines that incorporate common points of the main protocols found in the literature for the resumption of dental activities at their different levels, whether in the scope of care or education, are presented. Furthermore, we present the incorporation of measures that allow an increase in the level of biosafety, such as the control of the dental team, the inclusion in the history of conjunctivitis as a possible alert for COVID-19, and the use of the pulse oximeter to assess the risk of silent hypoxemia, which may indicate a complication of COVID-19. In addition, new perspectives for directing research and innovation for biosafety in dentistry are discussed.
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20
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Landis BC, Brooks AE, Digre KB, Seay MD. Coronavirus Disease 2019, Eye Pain, Headache, and Beyond. J Neuroophthalmol 2022; 42:18-25. [PMID: 35051986 DOI: 10.1097/wno.0000000000001526] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
BACKGROUND Severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2), which causes Coronavirus Disease 2019 (COVID-19), emerged in December 2019 and became a devastating pandemic. Although its respiratory effects can be deadly and debilitating, it can lead to other systemic disorders, such as those causing eye pain and headache. This literature review aims to describe presentations of eye pain and headache in relation to COVID-19, with an emphasis on how these disorders help us to understand the pathophysiology of COVID-19. EVIDENCE ACQUISITION Literature was mined from the PubMed database using the key terms: "eye pain," "conjunctivitis," "episcleritis," "optic neuritis," "migraine," and "headache" in conjunction with "COVID-19" and "SARS-CoV-2." With the exception of general background pathology, articles that predated 2006 were excluded. Case reports, literature reviews, and meta-analyses were all included. Where SARS-CoV-2 research was deficient, pathology of other known viruses was considered. Reports of ocular manifestations of vision loss in the absence of eye pain were excluded. The primary search was conducted in June 2021. RESULTS The literature search led to a focused review of COVID-19 associated with conjunctivitis, episcleritis, scleritis, optic neuritis, and myelin oligodendrocyte glycoprotein-associated optic neuritis. Four distinct COVID-19-related headache phenotypes were identified and discussed. CONCLUSIONS Eye pain in the setting of COVID-19 presents as conjunctivitis, episcleritis, scleritis, or optic neuritis. These presentations add to a more complete picture of SARS-CoV-2 viral transmission and mechanism of host infection. Furthermore, eye pain during COVID-19 may provide evidence of hypersensitivity-type reactions, neurovirulence, and incitement of either novel or subclinical autoimmune processes. In addition, investigation of headaches associated with COVID-19 demonstrated 4 distinct phenotypes that follow third edition of the International Classification of Headache Disorders categories: headaches associated with personal protective equipment, migraine, tension-type headaches, and COVID-19-specific headache. Early identification of headache class could assist in predicting the clinical course of disease. Finally, investigation into the COVID-19-associated headache phenotype of those with a history of migraine may have broader implications, adding to a more general understanding of migraine pathology.
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Affiliation(s)
- Brianna C Landis
- Rocky Vista University College of Osteopathic Medicine (BCL, AEB), Ivins, Utah; and Departments of Ophthalmology and Neurology (KBD, MDS), University of Utah Moran Eye Center, Salt Lake City, Utah
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21
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Yousefi A, Ma Y, Roberts CJ, Moroi SE, Reilly MA. Hydrodynamic Interaction Between Tear Film and Air Puff From Noncontact Tonometry. Transl Vis Sci Technol 2022; 11:2. [PMID: 35103798 PMCID: PMC8819281 DOI: 10.1167/tvst.11.2.2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Purpose The purpose of this study was to investigate the mechanism of potential droplet formation in response to air puff deformation with two noncontact tonometers (NCTs). Methods Twenty healthy volunteers were examined using two NCTs, Ocular Response Analyzer and Corvis ST, and two contact tonometers, iCare and Tono-Pen. High-speed videos of the tear film response were captured with at spatial resolution of 20 microns/pixel at 2400 fps. Droplet size, droplet velocity, distance between air puff impact location, and the tear meniscus-lid margin were characterized. Results One subject was excluded due to technical issues. Droplets were detected only in tests with instilled eye drop. Videos showed the tear film rolls away from the apex while remaining adherent to the ocular surface due to the tendency of the fluid to remain attached to a solid surface explained by the Coanda effect. Twelve out of 38 videos with an eye drop administration showed droplet formation. Only one resulted in droplets with predominantly forward motion, which had the shortest distance between air puff impact location and lower meniscus. This distance on average was 5.9 ± 1.1 mm. The average droplet size was 500 ± 200 µm. Conclusions Results indicate no droplet formation under typical clinical setting. Hence, standard clinical use of NCT tests is not expected to cause droplets. NCT testing with eye drop administration showed droplet formation at the inferior eyelid boundary, which acts as a barrier and interrupts tear flow. Translational Relevance Study of tear film interaction with NCT air puff shows that these tonometers are not expected to cause droplet formation in standard use and that if external drops are required, both eyelids should be held if patients need assistance to maintain open eyes to avoid droplets with predominantly forward motion.
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Affiliation(s)
- Atieh Yousefi
- Department of Ophthalmology & Visual Sciences, The Ohio State University College of Medicine, Columbus, OH, USA
| | - Yanhui Ma
- Department of Ophthalmology & Visual Sciences, The Ohio State University College of Medicine, Columbus, OH, USA
| | - Cynthia J Roberts
- Department of Ophthalmology & Visual Sciences, The Ohio State University College of Medicine, Columbus, OH, USA.,Department of Biomedical Engineering, The Ohio State University, Columbus, OH, USA
| | - Sayoko E Moroi
- Department of Ophthalmology & Visual Sciences, The Ohio State University College of Medicine, Columbus, OH, USA
| | - Matthew A Reilly
- Department of Ophthalmology & Visual Sciences, The Ohio State University College of Medicine, Columbus, OH, USA.,Department of Biomedical Engineering, The Ohio State University, Columbus, OH, USA
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22
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Ng XL, Betzler BK, Ng S, Chee SP, Rajamani L, Singhal A, Rousselot A, Pavesio CE, Gupta V, de Smet MD, Agrawal R. The Eye of the Storm: COVID-19 Vaccination and the Eye. Ophthalmol Ther 2022; 11:81-100. [PMID: 34914035 PMCID: PMC8675299 DOI: 10.1007/s40123-021-00415-5] [Citation(s) in RCA: 38] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2021] [Accepted: 10/21/2021] [Indexed: 12/12/2022] Open
Abstract
The COVID-19 pandemic has galvanized the global response towards the development of new vaccines based on novel technologies at an unprecedented pace. Since the widespread implementation of vaccination campaigns, case reports on vaccines' systemic side effects, including ocular manifestations, have emerged. Since administered vaccines are generally not able to cause the disease in the recipient, or induce an immune response against the pathogen, we hypothesize that the development of ocular phenomena post-COVID-19 vaccination may occur via an immune response elicited by the vaccine. Of many, the most common ocular adverse events include facial nerve palsy, central venous sinus thrombosis and acute anterior uveitis. These COVID-19 vaccine-induced ocular (CVIO) adverse events could resemble the ocular findings in some of the COVID-19 patients. This review will provide a comprehensive overview of published ocular side effects potentially associated with COVID-19 vaccination and serve as a springboard for further research into CVIO adverse events.
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Affiliation(s)
- Xin Le Ng
- National Healthcare Group Eye Institute, Tan Tock Seng Hospital, Singapore, 308433, Singapore
| | - Bjorn Kaijun Betzler
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Sean Ng
- Lee Kong Chian School of Medicine, Singapore, Singapore
| | - Soon Phaik Chee
- Singapore National Eye Centre, Singapore, Singapore
- Singapore Eye Research Institute, The Academia, Singapore, Singapore
- Department of Ophthalmology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- Department of Ophthalmology and Visual Sciences Academic Clinical Program, Duke-NUS Medical School, Singapore, Singapore
| | - Lakshminarayanan Rajamani
- Singapore Eye Research Institute, The Academia, Singapore, Singapore
- Department of Ophthalmology and Visual Sciences Academic Clinical Program, Duke-NUS Medical School, Singapore, Singapore
| | - Amit Singhal
- A*STAR ID Labs & Singapore Immunology Network (SIgN), Singapore, Singapore
| | - Andres Rousselot
- Department of Ophthalmology, Universidad del Salvador, Buenos Aires, Argentina
| | | | - Vishali Gupta
- Department of Ophthalmology, Advance Eye Centre, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Marc D de Smet
- MicroInvasive Ocular Surgery Clinic, Lausanne, Switzerland
- Department of Ophthalmology, University of Leiden, Leiden, The Netherlands
| | - Rupesh Agrawal
- National Healthcare Group Eye Institute, Tan Tock Seng Hospital, Singapore, 308433, Singapore.
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore.
- Lee Kong Chian School of Medicine, Singapore, Singapore.
- Singapore Eye Research Institute, The Academia, Singapore, Singapore.
- Department of Ophthalmology and Visual Sciences Academic Clinical Program, Duke-NUS Medical School, Singapore, Singapore.
- Moorfields Eye Hospital, NHS Foundation Trust, London, UK.
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23
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Karakus S, Foster J, Dai X, Gonzales A, Zhu X, Eberhart C, Hsu W. Prevalence of SARS-CoV-2 in Conjunctival Swab Samples Among Patients Presenting with Conjunctivitis During the COVID-19 Pandemic. Clin Ophthalmol 2022; 16:127-133. [PMID: 35046637 PMCID: PMC8763262 DOI: 10.2147/opth.s343793] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2021] [Accepted: 12/14/2021] [Indexed: 01/08/2023] Open
Abstract
Purpose To investigate the prevalence of SARS-CoV-2-associated conjunctivitis among patients presenting with conjunctivitis to ophthalmology clinics in the absence of respiratory symptoms suggesting COVID-19 during the first year of the pandemic. Patients and Methods This prospective, observational, cross-sectional study enrolled patients aged 18 years and older who presented with acute conjunctivitis between May 2020 and May 2021. After reviewing demographics, ocular and systemic symptoms, a slit lamp examination was performed. Five samples were collected (conjunctival swab from each eye, nasal swab from each nostril, and a nasopharyngeal swab) in separate tubes for a reverse transcription-polymerase chain reaction test for SARS-CoV-2. Patients were called at 1 and 2 weeks to follow up on their ocular and systemic symptoms and collect information about conjunctival adenovirus test results and COVID-19 test results if performed outside of the study. Results A total of 36 patients were enrolled. The most common ocular symptom was redness (35/36, 97%), and 14 patients (39%) had symptoms in both eyes at the time of the presentation. SARS-CoV-2 RNA was not detected in any samples collected during the study visit (95% confidence interval [CI] from 0 to 0.08). None of the study participants were diagnosed with COVID-19 following conjunctivitis during the 2-week follow-up period. We found that 25 patients had a conjunctival adenovirus test done on the day of their study visit, 9 of which reported positive results. Conclusion Our data suggest that it may not be valuable to obtain routine testing of SARS-CoV-2 in patients presenting with conjunctivitis in the absence of COVID-19.
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Affiliation(s)
- Sezen Karakus
- Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - James Foster
- Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Xi Dai
- Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, MD, USA.,Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Anthony Gonzales
- Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Xi Zhu
- Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, MD, USA.,Department of Biology, Public Health Studies, Krieger School of Arts and Sciences, Johns Hopkins University, Baltimore, MD, USA
| | - Charles Eberhart
- Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - William Hsu
- Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, MD, USA.,Department of Molecular and Cell Biology, Krieger School of Arts and Sciences, Johns Hopkins University, Baltimore, MD, USA
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Elashri M, Sabry I, Elhoseny M, Emara E, Taha DE, Sadek N. The ocular surface manifestation in ICU coronavirus disease-infected patients: a matched-pair analysis. JOURNAL OF THE EGYPTIAN OPHTHALMOLOGICAL SOCIETY 2022. [DOI: 10.4103/ejos.ejos_50_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
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25
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Mocanu V, Bhagwani D, Sharma A, Borza C, Rosca CI, Stelian M, Bhagwani S, Haidar L, Kshtriya L, Kundnani NR, Horhat FR, Horhat R. COVID-19 and the Human Eye: Conjunctivitis, a Lone COVID-19 Finding - A Case-Control Study. Med Princ Pract 2022; 31:66-73. [PMID: 34986482 PMCID: PMC8995668 DOI: 10.1159/000521808] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2021] [Accepted: 12/26/2021] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVES COVID-19 has varied clinical manifestations, from asymptomatic to severe cases, and conjunctivitis is one of them, but sometimes a lone initial symptom is found to be present. The aim of this study was to identify the prevalence of conjunctivitis as the first symptom in COVID-19 patients in a primary healthcare unit. METHODOLOGY A retrospective study was conducted, analyzing the presenting complains/symptoms and results of COVID-19-confirmatory tests. RESULTS Out of the 672 cases that were sent for RT-PCR testing, only 121 (18%) were found to be positive. Among these, 2.67% patients had both conjunctivitis and COVID-19, 77.77% patients had unilateral eye affected, while 22.22% had bilateral conjunctivitis of varying degrees. Fifteen patients diagnosed to have both acute conjunctivitis and COVID-19 presented other symptoms associated with COVID-19 infection. Three patients had only acute conjunctivitis during their entire course of COVID-19. CONCLUSIONS Conjunctivitis is a symptom of COVID-19 and may be the first sign of the infection, until the onset of the classical manifestations; such patients may continue to be a viral reservoir. Physicians should not miss unilateral conjunctivitis as it can be the only presenting complaint of COVID-19 during the initial phase, which might worsen if undetected and can aid in the spread of the contagion.
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Affiliation(s)
- Valeria Mocanu
- Department of Ophthalmology, EYE-ENT Senzory-Tumoral Research Centre, Victor Babeș University of Medicine and Pharmacy Timisoara, Timisoara, Romania
| | | | - Abhinav Sharma
- Department of Cardiology, Victor Babes University of Medicine and Pharmacy Timisoara, Timisoara, Romania
- Department of Occupational Medicine, Municipal Emergency University Hospital, Arad, Romania
- Family Physician Clinic, Teremia Mare, Romania
| | - Claudia Borza
- Department of Functional Science, Discipline of Physiopathology, Center for Translational Research and Systems Medicine, Victor Babes University of Medicine and Pharmacy, Timisoara, Romania
| | - Ciprian Ilie Rosca
- Family Physician Clinic, Teremia Mare, Romania
- Department of Internal Medicine, Centre for Advanced Research in Cardiovascular Pathology and Hemostasis, “Victor Babes“ University of Medicine and Pharmacy Timisoara, Timisoara, Romania
| | - Morariu Stelian
- Department of Occupational Medicine, Municipal Emergency University Hospital, Arad, Romania
- Department of Occupational Medicine, Vasile Goldis West University, Arad, Romania
| | | | - Laura Haidar
- Department of Functional Sciences, Physiology, Centre of Immuno-Physiology and Biotechnologies, Victor Babes University of Medicine and Pharmacy, Timisoara, Romania
| | | | - Nilima Rajpal Kundnani
- Family Physician Clinic, Teremia Mare, Romania
- Department of Functional Sciences, Physiology, Centre of Immuno-Physiology and Biotechnologies, Victor Babes University of Medicine and Pharmacy, Timisoara, Romania
- Shreeji Clinic, Ahmedabad, India
- *Nilima Rajpal Kundnani,
| | - Florin-Raul Horhat
- Department of Functional Science, Medical Informatics and Biostatistics, “Victor Babeș“ University of Medicine and Pharmacy Timisoara, Timisoara, Romania
| | - Raluca Horhat
- Department of Functional Science, Biophysics, “Victor Babeș“ University of Medicine and Pharmacy Timisoara, Timisoara, Romania
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26
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Al-Nashar H, Awad A, Ateya M. Conjunctival swab assessment among hospitalized patients with confirmed coronavirus disease 2019 at Zagazig University Hospitals, Egypt. DELTA JOURNAL OF OPHTHALMOLOGY 2022. [DOI: 10.4103/djo.djo_47_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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27
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Lin TP, Ko CN, Zheng K, Lai KH, Wong RL, Lee A, Zhang S, Huang SS, Wan KH, Lam DS. COVID-19: Update on Its Ocular Involvements, and Complications From Its Treatments and Vaccinations. Asia Pac J Ophthalmol (Phila) 2021; 10:521-529. [PMID: 34839344 PMCID: PMC8673850 DOI: 10.1097/apo.0000000000000453] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2021] [Accepted: 10/10/2021] [Indexed: 01/08/2023] Open
Abstract
ABSTRACT The coronavirus disease 2019 (COVID-19) came under the attention of the international medical community when China first notified the World Health Organization of a pneumonia outbreak of then-unknown etiology in Wuhan in December 2019. Since then, COVID-19 caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has appalled the world by spreading at a pandemic speed. Although ophthalmologists do not directly engage in the clinical care of COVID-19 patients, the ophthalmology community has become aware of the close ties between its practice and the pandemic. Not only are ophthalmologists at heightened risk of SARS-CoV-2 exposure due to their physical proximity with patients in routine ophthalmic examinations, but SARS-CoV-2 possesses ocular tropism resulting in ocular complications beyond the respiratory tract after viral exposure. Furthermore, patients could potentially suffer from adverse ocular effects in the therapeutic process. This review summarized the latest literature to cover the ophthalmic manifestations, effects of treatments, and vaccinations on the eye to aid the frontline clinicians in providing effective ophthalmic care to COVID-19 patients as the pandemic continues to evolve.
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Affiliation(s)
- Timothy P.H. Lin
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong
| | | | - Ke Zheng
- C-MER (Beijing) Dennis Lam Eye Hospital, Beijing, China
| | - Kenny H.W. Lai
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong
- C-MER International Eye Care Group, Hong Kong
| | - Raymond L.M. Wong
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong
- C-MER International Eye Care Group, Hong Kong
| | - Allie Lee
- Department of Ophthalmology, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong
| | | | - Suber S. Huang
- Retina Center of Ohio, Cleveland, OH, US
- Bascom Palmer Eye Institute, Miami, FL, US
| | - Kelvin H. Wan
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong
| | - Dennis S.C. Lam
- C-MER International Eye Research Center of The Chinese University of Hong Kong (Shenzhen), China
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Vallejo-Garcia JL, Balia L, Raimondi R, Rustioni G, Camesasca FI, Borgia A, Fossati G, Confalonieri F, Legrottaglie EF, Casari E, Sandri MT, Vinciguerra P. Conjunctivitis as a sign of persistent SARS-COV-2 infection? An observational study and report of late symptoms. Eur J Ophthalmol 2021; 32:11206721211056594. [PMID: 34761693 PMCID: PMC8935141 DOI: 10.1177/11206721211056594] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Accepted: 10/04/2021] [Indexed: 11/22/2022]
Abstract
PURPOSE To investigate if symptomatic conjunctivitis during the recovery phase of the disease could be associated to a persistent presence of SARS-CoV-2 in the upper respiratory tract. Secondary end points were to analyze the presence of SARS-CoV-2 in the conjunctiva of ocular symptomatic patients and to record the presence of ocular disturbances at this point of the disease. METHODS An observational study including consecutive COVID19 patients treated at Humanitas Clinical and Research Hospital who were attending for nasopharyngeal swab to confirm the resolution of SARS-CoV-2 infection and end of isolation. We examined 129 consecutive patients from May to June 2020. The primary end point was to determine if symptomatic conjunctivitis at this point of the disease could be associated to a persistent presence of SARS-CoV-2 in the upper respiratory tract. Secondary end points were to analyze the presence of SARS-CoV-2 in the conjunctiva of ocular symptomatic patients and to record the presence of ocular disturbances at this point of the disease. RESULTS One hundred twenty eight patients were included, 9.38% had conjunctivitis, none resulted positive to conjunctival PCR swab test, while two of them had positive nasopharyngeal result. Mean time elapsed since the first COVID-19 positive swab to the time of examination was 6 weeks ( ± 3). The only significant association was the presence of conjunctivitis with older age (65.3 ± 12.7 vs 56.7 + 13.5. p = 0.046). Nasopharyngeal swab resulted positive in 22 patients (17.19%). While 88 patients (68.2%) did not have any ocular complain during their COVID19 disease. The 40 patients (31.8%) reporting ocular disturbances complained about: redness (25.43%), tearing (19.53%), burning (18.35%), foreign body sensation (17.18%), itching (15.62%), and discharge (12.5%). CONCLUSION This study showed that late conjunctivitis cannot be considered as a marker of persistent infection when patients are sent to confirm the resolution of SARS-CoV-2 infection.
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Affiliation(s)
- Jose Luis Vallejo-Garcia
- IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
- Department of Biomedical Sciences, Humanitas University, Milan, Italy
| | - L Balia
- IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
| | - R Raimondi
- IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
- Department of Biomedical Sciences, Humanitas University, Milan, Italy
| | - G Rustioni
- IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
| | - FI Camesasca
- IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
| | - A Borgia
- IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
- Department of Biomedical Sciences, Humanitas University, Milan, Italy
| | - G Fossati
- IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
- Department of Biomedical Sciences, Humanitas University, Milan, Italy
| | - F Confalonieri
- IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
- Department of Biomedical Sciences, Humanitas University, Milan, Italy
| | | | - E Casari
- IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
| | - MT Sandri
- IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
- Department of Biomedical Sciences, Humanitas University, Milan, Italy
| | - P Vinciguerra
- IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
- Department of Biomedical Sciences, Humanitas University, Milan, Italy
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29
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Alnajjar M, Al-Mashdali A, Nefatti N. COVID-19 case presented initially with keratoconjunctivitis: A case report. Ann Med Surg (Lond) 2021; 71:102957. [PMID: 34691451 PMCID: PMC8520444 DOI: 10.1016/j.amsu.2021.102957] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2021] [Revised: 10/13/2021] [Accepted: 10/14/2021] [Indexed: 01/22/2023] Open
Abstract
Introduction Ocular complaints are considered non-classical presentations for COVID-19 infection; the initial diagnosis of keratoconjunctivitis is even rarer. Indeed, this puts treating clinicians in danger of getting infected, especially when patients present without the classic respiratory symptoms. Case Here we report a case of COVID-19 that was initially presented with keratoconjunctivitis with the appearance of respiratory symptoms four days later. The case showed improvement within four days of successful treatment for both covid pneumonia and ocular disease. Discussion Countable cases reported initial ocular symptoms to co-occur with systemic symptoms or even before. Only two cases reported the diagnosis of keratoconjunctivitis in COVID-19. The two cases differ in the proposed mechanism of developing such disorder. One by direct invasion of the virus, the other one by cytokines-induced epithelial injury. Our case did not show positivity for SARS-CoV 2 in the eye secretion, which aligns with the later proposed mechanism of pathology. Conclusion It is crucial to report such cases to increase the awareness of atypical presentation for COVID-19 infection. This is too important for two reasons: first, to diagnose the disease itself, and second, to take infection control precautions when treating such cases, with unexpected initial presentation. Atypical presentation for COVID-19 infection. COVID-19 may initially present with ocular complains. Countable cases reported initial ocular symptoms to co-occur with systemic symptoms. Infectivity either by direct invasion or cytokines-induced epithelial injury.
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Affiliation(s)
- Mohammed Alnajjar
- Division of Internal Medicine, Hamad Medical Corporation, Doha, Qatar
| | | | - Nedia Nefatti
- Division of Internal Medicine, Hamad Medical Corporation, Doha, Qatar
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30
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Zengin N, Güven YZ. Retinal microvascular and perfusional disruption in paediatric COVID-19: A case-control optical coherence tomography angiography study. Photodiagnosis Photodyn Ther 2021; 36:102577. [PMID: 34648992 PMCID: PMC8503975 DOI: 10.1016/j.pdpdt.2021.102577] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2021] [Revised: 09/12/2021] [Accepted: 09/27/2021] [Indexed: 12/23/2022]
Abstract
Purpose To investigate the short-term effect of coronavirus 2019 (COVID-19) on the retinal capillary network and choroid in children. Materials and methods This prospective, cross-sectional, case-control study included 19 recovered COVID-19 pediatric patients and 20 healthy children. Macular thickness, choroidal thickness, vessel density (VD), perfusion density (PD), and foveal avascular zone (FAZ) values were obtained. Central vessel and perfusion densities were measured at the central 6-mm area, and the values were compared among three subgroups according to location. Results The mean ages of patients and controls were 12. 42 ± 3.3 years and 13.35 ± 1.2 years, respectively. Significant differences were observed between the two groups in terms of inner, outer, and full VD, as well as inner and full PD. No significant differences in center VD and PD were observed between groups. Although it was not evident in analysis of choroidal values, inflammatory sites were thickened. FAZ area significantly differed between groups (p < 0.05). Conclusions Retinal microvascularity was impaired in the acute phase of disease in recovered COVID-19 patients aged 10–15 years. However, the microvascularity impairment was subclinical. The choroid was thickened because of inflammation during the acute phase of disease. pediatric COVID-19 patients should undergo follow up via optical coherence tomography angiography to detect subclinical and asymptomatic retinal changes. Long-term follow-up studies are needed to validate these findings.
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Affiliation(s)
- Neslihan Zengin
- Celal Bayar University, Hafsa Sultan Hospital, Department of Pediatrics, Manisa, Turkey
| | - Yusuf Ziya Güven
- İzmir Katip Çelebi University Atatürk Educating and Research Hospital, Department of Ophthalmology, 35200 İzmir, Turkey.
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31
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Gijs M, Veugen JMJ, Wolffs PFG, Savelkoul PHM, Tas J, van Bussel BCT, de Kruif MD, Henry RMA, Webers CAB, Dickman MM, Nuijts RMMA. In-Depth Investigation of Conjunctival Swabs and Tear Fluid of Symptomatic COVID-19 Patients, an Observational Cohort Study. Transl Vis Sci Technol 2021; 10:32. [PMID: 34673905 PMCID: PMC8543390 DOI: 10.1167/tvst.10.12.32] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Accepted: 09/15/2021] [Indexed: 01/08/2023] Open
Abstract
Purpose The putative presence of SARS-CoV-2 in ocular specimen puts healthcare workers at risk. We thoroughly examined conjunctival swabs and tear fluid in a large cohort of COVID-19 patients. Methods A total of 243 symptomatic laboratory-confirmed COVID-19 patients were included in this observational multicenter study. Conjunctival swabs were analyzed by reverse transcription polymerase chain reaction for detection of SARS-CoV-2 RNA. Next-generation sequencing and phylogenetic analysis were performed to identify viral strains and to determine tissue tropism. Schirmer tear samples from 43 hospitalized COVID-19 patients and 25 healthy controls were analyzed by multiplex cytokine immunoassays. Results Viral SARS-CoV-2 RNA was detected in conjunctival swabs from 17 (7.0%) of 243 COVID-19 patients. Conjunctival samples were positive for viral SARS-CoV-2 RNA as long as 12 days after disease onset. Cycle threshold (Ct) values for conjunctival swabs (mean 34.5 ± 5.1) were significantly higher than nasopharyngeal swabs (mean 16.7 ± 3.6). No correlation between Ct values of conjunctival and nasopharyngeal swabs was observed. The majority of positive conjunctival samples were detected only once and primarily during the first visit. Next-generation sequencing analysis revealed that the virus strain found in the conjunctiva was most often identical to the one found in the nasopharynx. Tear cytokine levels IL-1β and IL-6 were elevated in COVID-19 patients compared to healthy controls. Conclusions Conjunctival samples that were positive for SARS-CoV-2 RNA contained the same viral strain as the nasopharynx. Translational Relevance The presence of SARS-CoV-2 viral RNA and elevated cytokines in tear fluid confirm the involvement of the ocular surface in COVID-19 disease.
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Affiliation(s)
- Marlies Gijs
- University Eye Clinic Maastricht, Maastricht University Medical Center, Maastricht, the Netherlands
- School for Mental Health and Neuroscience (MHeNs), Maastricht University, Maastricht, the Netherlands
| | - Judith M. J. Veugen
- University Eye Clinic Maastricht, Maastricht University Medical Center, Maastricht, the Netherlands
- School for Mental Health and Neuroscience (MHeNs), Maastricht University, Maastricht, the Netherlands
- Department of Medical Microbiology, Maastricht University Medical Center, Maastricht, the Netherlands
- Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, the Netherlands
| | - Petra F. G. Wolffs
- Department of Medical Microbiology, Maastricht University Medical Center, Maastricht, the Netherlands
- Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, the Netherlands
| | - Paul H. M. Savelkoul
- Department of Medical Microbiology, Maastricht University Medical Center, Maastricht, the Netherlands
- Department of Medical Microbiology and Infection Control, Amsterdam Infection and Immunity Institute, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Jeanette Tas
- School for Mental Health and Neuroscience (MHeNs), Maastricht University, Maastricht, the Netherlands
- Department of Intensive Care Medicine, Maastricht University Medical Center, Maastricht, the Netherlands
| | - Bas C. T. van Bussel
- Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, the Netherlands
- Department of Intensive Care Medicine, Maastricht University Medical Center, Maastricht, the Netherlands
| | - Martijn D. de Kruif
- Department of Pulmonary Medicine, Zuyderland Medical Center, Heerlen, the Netherlands
| | - Ronald M. A. Henry
- Department of Internal Medicine, Maastricht University Medical Center, Maastricht, the Netherlands
| | - Carroll A. B. Webers
- University Eye Clinic Maastricht, Maastricht University Medical Center, Maastricht, the Netherlands
- School for Mental Health and Neuroscience (MHeNs), Maastricht University, Maastricht, the Netherlands
| | - Mor M. Dickman
- University Eye Clinic Maastricht, Maastricht University Medical Center, Maastricht, the Netherlands
- School for Mental Health and Neuroscience (MHeNs), Maastricht University, Maastricht, the Netherlands
| | - Rudy M. M. A. Nuijts
- University Eye Clinic Maastricht, Maastricht University Medical Center, Maastricht, the Netherlands
- School for Mental Health and Neuroscience (MHeNs), Maastricht University, Maastricht, the Netherlands
- Department of Ophthalmology, Zuyderland Medical Center, Heerlen, the Netherlands
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32
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Sehgal G, Bal P, Bal B, Chopra R. Pattern of ocular manifestations and the prevalence of severe acute respiratory syndrome coronavirus-2 in tears of hospitalized coronavirus disease 2019 patients. Taiwan J Ophthalmol 2021; 11:380-385. [PMID: 35070667 PMCID: PMC8757522 DOI: 10.4103/tjo.tjo_40_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Accepted: 09/25/2021] [Indexed: 01/08/2023] Open
Abstract
PURPOSE: Severe acute respiratory syndrome coronavirus2 (SARSCoV2) can affect eyes in various forms. Furthermore, ocular surface can act as potential port of entry and ocular secretions as possible route of transmission of SARSCoV2. The aims of the study are to identify ocular manifestation in confirmed coronavirus disease 2019 (COVID19) patients and to evaluate conjunctival secretions as the possible route of transmission of this disease. MATERIALS AND METHODS: A prospective, populationbased, observational study was done. Ocular symptoms and signs of every hospitalized patient with SARSCoV2 infection between September 15, 2020, and November 15, 2020, were recorded. Tear samples of the first 60 participants (30 each of patients with severe and moderate illness, can be removed) with ocular manifestations were selected for real-time polymerase chain reaction (RTPCR). Data were analyzed using the Statistical Package for the Social Science Software (SPSS) program, version 23. When comparing mean values, ttest was used otherwise Chisquare test. RESULTS: Out of 804 admitted patients during study period, 309 (38.4%) patients were identified with ocular manifestations, out of which 78% (241) had conjunctival hyperemia, 65.6% (203) had follicular reaction in palpebral conjunctiva, 58% (180) had chemosis, and 58% (99) had discharge and 18.4% (57) complained of burning in their eyes. Mean duration from systemic manifestation to onset of ocular symptoms was 4.52 ± 1.47 days while 8 patients (1%) had conjunctivitis as the presenting symptom. SARSCoV2 was detected in 18.3% patients (11 out of 60) using RTPCR. CONCLUSION: The presence of SARSCoV2 in ocular secretions of patients with ocular manifestations suggests that COVID19infected patients with ocular manifestations should wear protective glasses to prevent secretions contamination to healthy persons.
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Affiliation(s)
- Gaurang Sehgal
- Department Of Ophthalmology, Regional Institute of Ophthalmology, Amritsar, Punjab, India
| | - Prempal Bal
- Department Of Ophthalmology, Regional Institute of Ophthalmology, Amritsar, Punjab, India
| | - Bhavkaran Bal
- Department Of Ophthalmology, Regional Institute of Ophthalmology, Amritsar, Punjab, India
| | - Riya Chopra
- Department Of Ophthalmology, Regional Institute of Ophthalmology, Amritsar, Punjab, India
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Siwal SS, Chaudhary G, Saini AK, Kaur H, Saini V, Mokhta SK, Chand R, Chandel UK, Christie G, Thakur VK. Key ingredients and recycling strategy of personal protective equipment (PPE): Towards sustainable solution for the COVID-19 like pandemics. JOURNAL OF ENVIRONMENTAL CHEMICAL ENGINEERING 2021; 9:106284. [PMID: 34485055 PMCID: PMC8404393 DOI: 10.1016/j.jece.2021.106284] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/02/2021] [Revised: 07/26/2021] [Accepted: 08/25/2021] [Indexed: 05/24/2023]
Abstract
The COVID-19 pandemic has intensified the complications of plastic trash management and disposal. The current situation of living in fear of transmission of the COVID-19 virus has further transformed our behavioural models, such as regularly using personal protective equipment (PPE) kits and single-use applications for day to day needs etc. It has been estimated that with the passage of the coronavirus epidemic every month, there is expected use of 200 billion pieces of single-use facemasks and gloves. PPE are well established now as life-saving items for medicinal specialists to stay safe through the COVID-19 pandemic. Different processes such as glycolysis, hydrogenation, aminolysis, hydrolysis, pyrolysis, and gasification are now working on finding advanced technologies to transfer waste PPE into value-added products. Here, in this article, we have discussed the recycling strategies of PPE, important components (such as medical gloves, gowns, masks & respirators and other face and eye protection) and the raw materials used in PPE kits. Further, the value addition methods to recycling the PPE kits, chemical & apparatus used in recycling and recycling components into value-added products. Finally, the biorenewable materials in PPE for textiles components have been discussed along with concluded remarks.
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Affiliation(s)
- Samarjeet Singh Siwal
- Department of Chemistry, M.M. Engineering College, Maharishi Markandeshwar (Deemed to be University), Mullana, Ambala, Haryana 133207, India
| | - Gauri Chaudhary
- Department of Chemistry, M.M. Engineering College, Maharishi Markandeshwar (Deemed to be University), Mullana, Ambala, Haryana 133207, India
| | - Adesh Kumar Saini
- Department of Biotechnology, Maharishi Markandeshwar (Deemed to be University), Mullana, Ambala, Haryana 133207, India
| | - Harjot Kaur
- Department of Chemistry, M.M. Engineering College, Maharishi Markandeshwar (Deemed to be University), Mullana, Ambala, Haryana 133207, India
| | - Vipin Saini
- Department of Pharmacy, Maharishi Markandeshwar University, Kumarhatti, Solan, Himachal Pradesh, 173229, India
| | - Sudesh Kumar Mokhta
- Department of Environment, Science & Technology, Government of Himachal Pradesh, 171001, India
| | - Ramesh Chand
- Department of Health and Family Welfare, Government of Himachal Pradesh, 171001, India
| | - U K Chandel
- Department of surgery, Indira Gandhi Medical College and Hospital (IGMC), Shimla, Himachal Pradesh 171001, India
| | - Graham Christie
- Institute of Biotechnology, Department of Chemical Engineering and Biotechnology, University of Cambridge, Cambridge CB2 1QT, UK
| | - Vijay Kumar Thakur
- Biorefining and Advanced Materials Research Center, SRUC, Kings Buildings, Edinburgh EH9 3JG, UK
- Enhanced Composites and Structures Center, School of Aerospace, Transport and Manufacturing, Cranfield University, Bedfordshire MK43 0AL, UK
- Faculty of Materials Science and Applied Chemistry Institute of Polymer Materials, Riga Technical University, P.Valdena 3/7, LV, 1048 Riga, Latvia
- Department of Mechanical Engineering, School of Engineering, Shiv Nadar University, Uttar Pradesh 201314, India
- School of Engineering, University of Petroleum & Energy Studies (UPES), Dehradun, Uttarakhand, India
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Ranzenigo M, Bruzzesi E, Galli L, Castagna A, Ferrari G. Symptoms and signs of conjunctivitis as predictors of disease course in COVID-19 syndrome. J Ophthalmic Inflamm Infect 2021; 11:35. [PMID: 34553288 PMCID: PMC8457539 DOI: 10.1186/s12348-021-00264-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2021] [Accepted: 09/05/2021] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) can induce conjunctivitis signs and symptoms. However, limited information is available on their impact on COVID-19 disease phenotype. Quantification of ocular signs/symptoms can provide a rapid, non-invasive proxy for predicting clinical phenotype. Moreover, the existence and entity of conjunctival viral shedding is still debated. This has relevant implications to manage disease spread. The purpose of this study was to investigate conjunctivitis signs and symptoms and their correlation with clinical parameters, conjunctival viral shedding in patients with COVID-19. METHODS Fifty-three patients hospitalized between February 25th and September 16th, 2020 at the San Raffaele Hospital, in Milan, Lombardy, Italy with a confirmed diagnosis of SARS-CoV-2 were evaluated. Presence of interstitial pneumonia was confirmed with computed tomography scan imaging. Ocular signs and symptoms, anosmia/ageusia, clinical/laboratory parameters, and reverse transcriptase-polymerase chain reaction (RT-PCR) from nasopharyngeal and conjunctival swabs for COVID-19 virus were analyzed. RESULTS Forty-six out of 53 patients showed a positive nasopharyngeal swab for SARS-CoV-2 infection at the time of conjunctival evaluation. All the conjunctival swabs were negative. Conjunctivitis symptoms were present in 37% of patients. Physician-assessed ocular signs were detected in 28% of patients. Patients with ocular symptoms or signs tended to be older: 76.8 years (62.4-83.3) vs 57.2 years (48.1-74.0), p = 0.062 and had a longer hospitalization: 38 days (18-49) vs. 14 days (11-21), p = 0.005. Plasma levels of Interleukin-6 were higher in patients with signs or symptoms in comparison with those without them: 43.5 pg/ml (19.7-49.4) vs. 8 pg/ml (3.6-20.7), p = 0.02. Red cell distribution width was also significantly higher: 15 (14.3-16.7) vs 13.2 (12.4-14.4), p = 0.001. CONCLUSIONS We found that over a third of the patients had ocular signs or symptoms. These had higher prevalence in patients with a more severe infection. No viral shedding was detected in the conjunctiva. Our results suggest that prompt detection of conjunctivitis signs/symptoms can serve as a helpful proxy to predict COVID-19 clinical phenotype.
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Affiliation(s)
- Martina Ranzenigo
- Infectious Diseases, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Elena Bruzzesi
- Infectious Diseases, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Laura Galli
- Infectious Diseases, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Antonella Castagna
- Infectious Diseases, IRCCS San Raffaele Scientific Institute, Milan, Italy
- Vita-Salute San Raffaele University, Milan, Italy
| | - Giulio Ferrari
- Cornea and Ocular Surface Disease Unit, Eye Repair Lab, IRCCS San Raffaele Scientific Institute, Via Olgettina, 60, 20132, Milan, Italy.
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Mohammad Alrawashdeh H, Al Zubi K, Abdulmannan DM, Al-Habahbeh O, Abu-Ismail L. Conjunctivitis as the only sign and symptom of COVID-19: A case report and review of literature. Qatar Med J 2021; 2021:31. [PMID: 34527545 PMCID: PMC8411033 DOI: 10.5339/qmj.2021.31] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2021] [Accepted: 05/24/2021] [Indexed: 11/27/2022] Open
Abstract
Similar to several viruses, coronaviruses can affect the eye and cause conjunctivitis. In addition to ocular involvement, it causes systemic manifestations, mainly respiratory symptoms. However, conjunctivitis as the only sign and symptom of coronavirus disease 2019 (COVID-19) is a rare presentation. We present a case of a 20-year-old male patient who presented with conjunctivitis for 3 days and diagnosed on the same day with COVID-19 without other manifestations. Conjunctivitis affected both eyes and resolved over 2 weeks with artificial tears only and without any ocular complications. Conjunctivitis can be the only sign and symptom of COVID-19 in some patients. Therefore, healthcare providers, particularly ophthalmologists, should take precautions when dealing with patients presenting with conjunctivitis amid the COVID-19 pandemic.
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Affiliation(s)
| | - Khalid Al Zubi
- Department of Special Surgeries, Faculty of medicine, Mutah University, Al Karak, Jordan
| | - Dina M Abdulmannan
- Ophthalmology Department, Faculty of Medicine, Umm Alqura University, Makkah, Saudi Arabia
| | - Omar Al-Habahbeh
- Ophthalmology Department, Ibn Al Haytham Hospital, Amman, Jordan
| | - Luai Abu-Ismail
- Department of Clinical Medical Sciences, Faculty of Medicine, Yarmouk University, Irbid, Jordan
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Szczęśniak M, Brydak-Godowska J. SARS-CoV-2 and the Eyes: A Review of the Literature on Transmission, Detection, and Ocular Manifestations. Med Sci Monit 2021; 27:e931863. [PMID: 34508064 PMCID: PMC8439119 DOI: 10.12659/msm.931863] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2021] [Accepted: 04/25/2021] [Indexed: 01/08/2023] Open
Abstract
During the coronavirus disease 2019 (COVID-19) pandemic, numerous reports of ocular anomalies occurring in patients infected with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) have emerged. The most frequently reported pathology is conjunctivitis, which may be the first or only clinical manifestation of the disease. Involvement of SARS-CoV-2 in development of alterations in other ocular structures was suggested, including the cornea, the retina, and blood vessels. Possible mechanisms include direct activity of the viral agent, as well as systemic inflammatory response with accompanying thromboembolic complications. Genetic material of SARS-CoV-2 was detected in ocular secretions of infected individuals, including asymptomatic patients. Moreover, angiotensin-converting enzyme 2 (ACE2), a receptor protein used by the virus to enter the cell, has been found on the surface of various structures of the eye, which indicates a risk of transmission through ocular tissues. Therefore, it is crucial to use eye protection by medical professionals having contact with potentially infected patients. This paper is a review of the literature regarding ocular manifestations of SARS-CoV-2 infection and a summary of the current state of knowledge about possibility of transmission from an ophthalmology point of view. For data collection, a thorough PubMed search was performed, using the key words: "COVID ocular", "COVID eye", "SARS-CoV-2 ocular", and "SARS-CoV-2 eye". Conclusions: SARS-CoV-2 infection may manifest itself in various ocular conditions. Eye protection should not be neglected, as recent studies suggest the eye as a potential route of transmission. Further search for adequate safety measures in ophthalmology practice is required.
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Mechel E, Trinh M, Kodsi S, Hymowitz M, Kainth MK, Lee AM. Ophthalmia neonatorum as the presenting sign of SARS-CoV-2. J AAPOS 2021; 25:230-231. [PMID: 33774164 PMCID: PMC7989099 DOI: 10.1016/j.jaapos.2021.03.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2021] [Revised: 03/09/2021] [Accepted: 03/14/2021] [Indexed: 11/28/2022]
Abstract
The most common ocular manifestation of SARS-CoV-2 in adults and children is acute conjunctivitis. We report the case of a 4-day-old infant who presented with acute-onset mucopurulent discharge of the left eye as well as subconjunctival hemorrhage and palpebral injection, without corneal findings. A diagnosis of ophthalmia neonatorum was established, for which ocular cultures and Gram staining were performed. No bacterial growth was noted, and polymerase chain reaction (PCR) testing for Chlamydia trachomatis, Neisseria gonorrhea, and herpes simplex were negative. Nasopharyngeal and conjunctival SARS-CoV-2 PCR were positive. Given the identification of SARS-CoV-2 illness, lack of other underlying bacterial or viral etiology on testing, and the well-documented ability for SARS-CoV-2 to cause conjunctivitis, the clinical picture was supportive of ophthalmia neonatorum secondary to SARS-CoV-2. The infant was treated with ceftriaxone and azithromycin prior to culture results. During admission, no systemic findings of Covid-19 illness were observed.
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Affiliation(s)
- Elzbieta Mechel
- Department of Ophthalmology, Northwell Health, Great Neck, New York
| | - Minh Trinh
- Department of Ophthalmology, Northwell Health, Great Neck, New York
| | - Sylvia Kodsi
- Department of Ophthalmology, Northwell Health, Great Neck, New York; Department of Pediatrics, Cohen Children's Medical Center, Northwell Health, Queens, New York; Donald and Barbara Zucker School of Medicine at Hofstra, Northwell Health, Hempstead, New York.
| | - Maggie Hymowitz
- Department of Ophthalmology, Northwell Health, Great Neck, New York; Donald and Barbara Zucker School of Medicine at Hofstra, Northwell Health, Hempstead, New York
| | - Mundeep K Kainth
- Department of Pediatrics, Cohen Children's Medical Center, Northwell Health, Queens, New York; Donald and Barbara Zucker School of Medicine at Hofstra, Northwell Health, Hempstead, New York; Institute of Molecular Medicine, Feinstein Institute for Medical Research, Northwell Health, Manhasset, New York
| | - Alice M Lee
- Department of Pediatrics, Cohen Children's Medical Center, Northwell Health, Queens, New York; Donald and Barbara Zucker School of Medicine at Hofstra, Northwell Health, Hempstead, New York
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Barabino S. A Narrative Review of Current Understanding and Classification of Dry Eye Disease with New Insights on the Impact of Dry Eye during the COVID-19 Pandemic. Ophthalmol Ther 2021; 10:495-507. [PMID: 34275088 PMCID: PMC8286160 DOI: 10.1007/s40123-021-00373-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2021] [Accepted: 07/01/2021] [Indexed: 01/18/2023] Open
Abstract
Dry eye disease (DED) is a complex, progressive and multifactorial condition that is commonly seen in clinical practice and can be challenging to accurately diagnose. Untreated or suboptimally managed dry eye can progress to severe, chronic disease which may become resistant to treatment. Symptoms include ocular irritation and visual impairment. Patients frequently report negative consequences regarding quality of life (QoL), productivity and psychological wellbeing. Certain lifestyle factors (e.g. use of screen-based devices, air conditioning) can induce or exacerbate symptoms of DED, leading to progressive and debilitating complications. Exposures to such triggers are likely to have increased significantly during the ongoing COVID-19 pandemic with people across the globe living with heightened levels of stress/anxiety while being forced to adapt most aspects of their daily lives (from work and education through to social activities) to accommodate social distancing, primarily through the use digital technologies. This review aims to provide a concise and practical overview of current understanding regarding DED, highlighting proposals for refined diagnostic categories and therapeutic terminologies that are designed to improve identification and management of dry eye as well as reduce or slow disease progression. Finally, the findings of a European survey are shared to illustrate the impact of the COVID-19 pandemic on the lives of people with DED. The survey was conducted during the first lockdown period (March–September 2020) and explored issues relating to psychological wellbeing, QoL and engagement with healthcare services. The results demonstrate the ways in which the pandemic amplified the impact of dry eye on daily life and may be valuable in enhancing understanding among clinicians of the challenges faced by people with DED, which extend beyond the signs and symptoms of disease.
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Affiliation(s)
- Stefano Barabino
- Centro Superficie Oculare e Occhio Secco, ASST Fatebenefratelli-Sacco, Ospedale L. Sacco, Università di Milano, via G.B. Grassi 74, 20157, Milan, Italy.
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Lima LCDF, Moraes Junior HV, Moraes HMV. COVID-19 Ocular Manifestations in the Early Phase of Disease. Ocul Immunol Inflamm 2021; 29:666-668. [PMID: 34242138 DOI: 10.1080/09273948.2021.1887278] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Purpose: To evaluate and establishe the number of patients with ocular manifestations in the early phase of systemic COVID-19 infection.Methods: A cross-sectional study was performed in a COVID-19 referral center regarding ocular findings in patients with COVID-19 in the first few days of the disease. The patients were submitted to a clinical examination, an ophthalmic exam and a RT-PCR for SARS-COV-2.Results: Out of 1740 patients, we reported 108 patients with ocular manifestations. Forty-nine with markedly conjunctivitis had conjunctival swab positive for SARS-COV-2, four of them developed keratitis. There were mostly no evidence of retinopathy nor decrease in visual acuity. They had no marked clinical symptoms, which can contribute and demonstrate that the virus may cause ocular disease as an only finding or in the very early stage of the infection.Conclusion: Patients were in the first days of COVID-19 infection, presented ocular manifestations suggested to be related to the virus and need to be aware of the pathways of transmissions.
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40
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Ran HL, Zhou XT, Liu WJ, Gao GF. Keep Eyes on COVID-19: Ophthalmic Symptoms and Potential Transmission of SARS-CoV-2 through the Oculus. INFECTIOUS DISEASES & IMMUNITY 2021; 1:103-107. [PMID: 38630078 PMCID: PMC8291037 DOI: 10.1097/id9.0000000000000011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/10/2021] [Indexed: 12/15/2022]
Abstract
In December 2019, a new coronavirus disease 2019 (COVID-19) emerged and rapidly spread globally, posing a worldwide health emergency. The pathogen causing this pandemic was identified as severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2). It is well known that SARS-CoV-2 transmits via respiratory droplets and close contact with infected individuals or contaminated items. In addition to these two major transmission routes, other modes of transmission have not been confirmed. Considering that some COVID-19 patients have presented with ocular discomforts and positive SARS-CoV-2 RNA in ocular surfaces, as well as the discovery of the SARS-CoV-2 receptors, angiotensin-converting enzyme 2, and transmembrane protease, serine 2, in the oculus, the ocular surface is now thought to be a possible alternative route of SARS-CoV-2 transmission and a replication site. This review summarizes the evidence connecting COVID-19 with ocular tissues, ocular symptoms during SARS-CoV-2 infection, the potential role of the conjunctiva in SARS-CoV-2 transmission, and the physiopathological mechanisms. Appropriate precautions in ophthalmology departments, including innovative complete and effective patient management plans, protective personal equipment, hand hygiene, and strict personal distance intervals, are essential to effectively minimize the spread of SARS-CoV-2 and control the pandemic.
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Affiliation(s)
- Hong Li Ran
- School of Ophthalmology and Optometry, Wenzhou Medical University, Wenzhou 325027, China
- National Institute for Viral Disease Control and Prevention, Chinese Center for Disease Control and Prevention (China CDC), Beijing 100052, China
| | - Xiang Tian Zhou
- School of Ophthalmology and Optometry, Wenzhou Medical University, Wenzhou 325027, China
| | - William J. Liu
- School of Ophthalmology and Optometry, Wenzhou Medical University, Wenzhou 325027, China
- National Institute for Viral Disease Control and Prevention, Chinese Center for Disease Control and Prevention (China CDC), Beijing 100052, China
| | - George F. Gao
- School of Ophthalmology and Optometry, Wenzhou Medical University, Wenzhou 325027, China
- National Institute for Viral Disease Control and Prevention, Chinese Center for Disease Control and Prevention (China CDC), Beijing 100052, China
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41
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Jin YP, Trope GE, El-Defrawy S, Liu EY, Buys YM. Ophthalmology-focused publications and findings on COVID-19: A systematic review. Eur J Ophthalmol 2021; 31:1677-1687. [PMID: 33557602 PMCID: PMC8369910 DOI: 10.1177/1120672121992949] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2020] [Accepted: 01/17/2021] [Indexed: 01/19/2023]
Abstract
PURPOSE To summarize COVID-19 research endeavors by ophthalmologists/researchers in terms of publication numbers, journals and author countries, and to detail key findings. METHODS The LitCovid database was systematically reviewed for ophthalmology-focused COVID-19 articles. The quality of the evidence was assessed for articles investigating conjunctivitis in COVID-19 patients. RESULTS There were 21,364 articles in LitCovid on June 12, 2020, of which 215 (1%) were ophthalmology-focused. Of articles on COVID-19 transmission, 3.3% were ophthalmology-focused. Ophthalmology-focused articles were published in 68 journals and originated from 25 countries. The top five countries publishing ophthalmology-focused articles (China, India, United States of America, Italy, and United Kingdom) produced 145/215 (67%) articles. A total of 16 case reports/series from eight countries reported that conjunctivitis can be the initial or the only symptom of COVID-19 infection. Conjunctivitis may occur in the middle phase of COVID-19 illness. A total of 10 hospital-based cross-sectional studies reported that between 0% and 31.6% of COVID-19 patients have conjunctivitis or other ocular conditions, with a pooled prevalence of 5.5% reported in a meta-analysis. Viral RNA was detected in conjunctival swabs of patients with and without ocular manifestations, after resolution of conjunctivitis, after nasopharyngeal swabs turned negative and in retina of deceased COVID-19 patients. CONCLUSION Within 3 months of declaring the COVID-19 pandemic, 215 ophthalmology-focused articles were published in PubMed, concentrating on disease manifestations and transmission. The reported presence of conjunctivitis or other ocular conditions in COVID-19 patients is varied. Clinicians should be alert for ocular involvement in COVID-19 infections and possible ocular transmission even in patients without ocular symptoms.
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Affiliation(s)
- Ya-Ping Jin
- Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, ON, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Graham E Trope
- Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, ON, Canada
| | - Sherif El-Defrawy
- Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, ON, Canada
| | - Elin Y Liu
- Department of Mechanical and Mechatronics Engineering, University of Waterloo, Toronto, ON, Canada
| | - Yvonne M Buys
- Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, ON, Canada
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Marcus GM, Olgin JE, Peyser ND, Vittinghoff E, Yang V, Joyce S, Avram R, Tison GH, Wen D, Butcher X, Eitel H, Pletcher MJ. Predictors of incident viral symptoms ascertained in the era of COVID-19. PLoS One 2021; 16:e0253120. [PMID: 34138915 PMCID: PMC8211176 DOI: 10.1371/journal.pone.0253120] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2020] [Accepted: 05/31/2021] [Indexed: 12/26/2022] Open
Abstract
Background In the absence of universal testing, effective therapies, or vaccines, identifying risk factors for viral infection, particularly readily modifiable exposures and behaviors, is required to identify effective strategies against viral infection and transmission. Methods We conducted a world-wide mobile application-based prospective cohort study available to English speaking adults with a smartphone. We collected self-reported characteristics, exposures, and behaviors, as well as smartphone-based geolocation data. Our main outcome was incident symptoms of viral infection, defined as fevers and chills plus one other symptom previously shown to occur with SARS-CoV-2 infection, determined by daily surveys. Findings Among 14, 335 participants residing in all 50 US states and 93 different countries followed for a median 21 days (IQR 10–26 days), 424 (3%) developed incident viral symptoms. In pooled multivariable logistic regression models, female biological sex (odds ratio [OR] 1.75, 95% CI 1.39–2.20, p<0.001), anemia (OR 1.45, 95% CI 1.16–1.81, p = 0.001), hypertension (OR 1.35, 95% CI 1.08–1.68, p = 0.007), cigarette smoking in the last 30 days (OR 1.86, 95% CI 1.35–2.55, p<0.001), any viral symptoms among household members 6–12 days prior (OR 2.06, 95% CI 1.67–2.55, p<0.001), and the maximum number of individuals the participant interacted with within 6 feet in the past 6–12 days (OR 1.15, 95% CI 1.06–1.25, p<0.001) were each associated with a higher risk of developing viral symptoms. Conversely, a higher subjective social status (OR 0.87, 95% CI 0.83–0.93, p<0.001), at least weekly exercise (OR 0.57, 95% CI 0.47–0.70, p<0.001), and sanitizing one’s phone (OR 0.79, 95% CI 0.63–0.99, p = 0.037) were each associated with a lower risk of developing viral symptoms. Interpretation While several immutable characteristics were associated with the risk of developing viral symptoms, multiple immediately modifiable exposures and habits that influence risk were also observed, potentially identifying readily accessible strategies to mitigate risk in the COVID-19 era.
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Affiliation(s)
- Gregory M. Marcus
- Division of Cardiology, Department of Medicine, University of California, San Francisco, California, United States of America
- * E-mail:
| | - Jeffrey E. Olgin
- Division of Cardiology, Department of Medicine, University of California, San Francisco, California, United States of America
| | - Noah D. Peyser
- Division of Cardiology, Department of Medicine, University of California, San Francisco, California, United States of America
| | - Eric Vittinghoff
- Division of Cardiology, Department of Medicine, University of California, San Francisco, California, United States of America
| | - Vivian Yang
- Division of Cardiology, Department of Medicine, University of California, San Francisco, California, United States of America
| | - Sean Joyce
- Division of Cardiology, Department of Medicine, University of California, San Francisco, California, United States of America
| | - Robert Avram
- Division of Cardiology, Department of Medicine, University of California, San Francisco, California, United States of America
| | - Geoffrey H. Tison
- Division of Cardiology, Department of Medicine, University of California, San Francisco, California, United States of America
| | - David Wen
- Division of Cardiology, Department of Medicine, University of California, San Francisco, California, United States of America
| | - Xochitl Butcher
- Division of Cardiology, Department of Medicine, University of California, San Francisco, California, United States of America
| | - Helena Eitel
- Division of Cardiology, Department of Medicine, University of California, San Francisco, California, United States of America
| | - Mark J. Pletcher
- Division of Cardiology, Department of Medicine, University of California, San Francisco, California, United States of America
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Shakaib B, Zohra T, Ikram A, Shakaib MB, Ali A, Bashir A, Salman M, Khan MA, Ansari J. A comprehensive review on clinical and mechanistic pathophysiological aspects of COVID-19 Malady: How far have we come? Virol J 2021; 18:120. [PMID: 34098986 PMCID: PMC8182739 DOI: 10.1186/s12985-021-01578-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2021] [Accepted: 05/17/2021] [Indexed: 01/08/2023] Open
Abstract
Since its outbreak in 2019, the coronavirus disease (COVID-19) has become a pandemic, affecting more than 52 million people and causing more than 1 million mortalities globally till date. Current research reveals a wide array of disease manifestations and behaviors encompassing multiple organ systems in body and immense systemic inflammation, which have been summarized in this review. Data from a number of scientific reviews, research articles, case series, observational studies, and case reports were retrieved by utilizing online search engines such as Cochrane, PubMed, and Scopus from December 2019 to November 2020. The data for prevalence of signs and symptoms, underlying disease mechanisms and comorbidities were analyzed using SPSS version 25. This review will discuss a wide range of COVID-19 clinical presentations recorded till date, and the current understanding of both the underlying general as well as system specific pathophysiologic, and pathogenetic pathways. These include direct viral penetration into host cells through ACE2 receptors, induction of inflammosomes and immune response through viral proteins, and the initiation of system-wide inflammation and cytokine production. Moreover, peripheral organ damage and underlying comorbid diseases which can lead to short term and long term, reversible and irreversible damage to the body have also been studied. We concluded that underlying comorbidities and their pathological effects on the body contributed immensely and determine the resultant disease severity and mortality of the patients. Presently there is no drug approved for treatment of COVID-19, however multiple vaccines are now in use and research for more is underway.
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Affiliation(s)
- Baila Shakaib
- Rawal Institute of Health Sciences, Islamabad, Pakistan
| | | | - Aamer Ikram
- National Institute of Health, Islamabad, Pakistan
| | | | - Amna Ali
- National Institute of Health, Islamabad, Pakistan
| | - Adnan Bashir
- National Institute of Health, Islamabad, Pakistan
| | | | | | - Jamil Ansari
- National Institute of Health, Islamabad, Pakistan
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Hao W, Wu J, Zhao X, Liang D, Yu X, Cao H, Wang Y. Quantitative Evaluation of Aerosol Generation from Non-contact Tonometry and its Correlation with Tear Film Characteristics. Adv Ther 2021; 38:3066-3076. [PMID: 33909233 PMCID: PMC8080094 DOI: 10.1007/s12325-021-01740-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2021] [Accepted: 04/07/2021] [Indexed: 01/03/2023]
Abstract
INTRODUCTION Ophthalmologists are inevitably exposed to tears and ocular discharge during ophthalmologic examinations and are at high risk for SARS-CoV-2 infection. To understand the role of aerosols in disease transmission, we adopted a prospective cross-sectional study design and investigated the count and size distribution of aerosols generated by a non-contact tonometer and its correlation with individual tear film characteristics. METHODS This study constituted two parts. The study population included outpatients who underwent an intraocular pressure examination in an intraocular pressure examination room (Part I) and 20 participants who underwent an intraocular pressure examination in a laboratory (Part II). The following main outcomes were measured: aerosol counts at 0, 50, 100, 150, and 200 cm from the non-contact tonometer (Part I); aerosol counts after each participant underwent non-contact tonometry, and lipid layer thickness score and tear film break-up time (Part II). RESULTS The aerosol count decreased with increasing distance from the tonometer. The aerosol count at 0 cm had the highest value compared to that at other distances. For aerosols of diameters 0.25-0.5 μm and 0.5-1.0 μm, the count decreased at 50 cm and remained stable at further distances. For aerosols of diameters 1.0-2.5 μm and ≥ 2.5 μm, the count dropped progressively at all five distances. The aerosol count from each tonometer correlated positively with the lipid layer thickness score (r = 0.490, P = 0.028), whereas the aerosol count correlated negatively with the tear film break-up time (r = - 0.675, P = 0.001). CONCLUSIONS Aerosols tended to coagulate during diffusion. A 50-cm distance from the tonometer could confer safety from aerosols with < 1.0-μm diameter. Aerosols generated during non-contact tonometry could contain a lipid layer component. Moreover, tear film stability could affect aerosol generation. Protective eyewear is recommended for reducing infection risk from aerosols. Individual tear film characteristics should be considered during non-contact tonometry.
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Affiliation(s)
- Weiting Hao
- Clinical College of Ophthalmology, Tianjin Medical University, Tianjin, China
| | - Jianhui Wu
- State Environmental Protection Key Laboratory of Urban Ambient Air Particulate Matter Pollution Prevention and Control, College of Environmental Science and Engineering, Nankai University, Tianjin, China
| | - Xinheng Zhao
- Clinical College of Ophthalmology, Tianjin Medical University, Tianjin, China
| | - Danni Liang
- Tianjin Shuangyun Environmental Protection Technology Co., Ltd, Tianjin, China
| | - Xingchen Yu
- Clinical College of Ophthalmology, Tianjin Medical University, Tianjin, China
| | - Huazheng Cao
- Clinical College of Ophthalmology, Tianjin Medical University, Tianjin, China
| | - Yan Wang
- Clinical College of Ophthalmology, Tianjin Medical University, Tianjin, China.
- Tianjin Eye Hospital, Tianjin Eye Institute, Tianjin Key Laboratory of Ophthalmology and Visual Science, Clinical College of Ophthalmology, Tianjin Medical University, No 4. Gansu Road, Heping District, Tianjin, 300020, China.
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45
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Eskian M, Rezaei N. Clinical Manifestations of COVID-19. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2021; 1318:179-196. [PMID: 33973179 DOI: 10.1007/978-3-030-63761-3_11] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is the third coronavirus causing an outbreak in the twenty-first century. It is related to a contagious coronavirus disease (COVID-19), which its high pace of spreading allowed it to lie to the whole world and be turned into a pandemic only a few months after the identification of the first case. Currently, the reverse transcription-polymerase chain reaction (RT-PCR) test of throat swap is the gold standard of diagnosis; however, several studies have reported false-negative results with non-ideal sensitivity. Because this pandemic constitutes a significant burden on global healthcare systems and due to the high transmission rate of the virus, an accurate diagnosis algorithm is needed to reduce the missing case number. A comprehensive clinical examination and taking a history of all systems (not just limited to the respiratory system) combined with hematologic laboratory tests and chest imaging can lead to a sensitive diagnosis, severity assessment, and RT-PCT test interpretation. This chapter focuses on clinical characteristics, hematologic laboratory, and chest imaging features in COVID-19.
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Affiliation(s)
- Mahsa Eskian
- Network of Immunity in Infection, Malignancy and Autoimmunity (NIIMA), Universal Scientific Education and Research Network (USERN), Tehran, Iran. .,Department of Radiology, Center for Evidence-Based Imaging, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA. .,Research Center for Immunodeficiencies, Children's Medical Center, Tehran University of Medical Sciences, Tehran, Iran.
| | - Nima Rezaei
- Network of Immunity in Infection, Malignancy and Autoimmunity (NIIMA), Universal Scientific Education and Research Network (USERN), Tehran, Iran. .,Research Center for Immunodeficiencies, Children's Medical Center, Tehran University of Medical Sciences, Tehran, Iran. .,Department of Immunology, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran.
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Arora R, Goel R, Saxena S, Manchanda V, Ahmad M, Gupta G, Chhabra M, Kumar S, Nguyen TMN, Payden, Pumma P, Saxena K. Comparative Evaluation of Tears and Nasopharyngeal Swab for SARS-CoV-2 in COVID-19 Dedicated Intensive Care Unit Patients. Ocul Immunol Inflamm 2021; 29:690-696. [PMID: 33974481 DOI: 10.1080/09273948.2021.1903938] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Purpose: To compare the cycle threshold (Ct) values of tears and nasopharyngeal (NP) swab in severe COVID-19 ICU patients with positive NP swabs.Procedure: A cross-sectional study for the detection of SARS-CoV-2 by real-time RT-PCR on simultaneously collected NP swabs and tears was performed. Detailed demographic profile, including comorbidities, ocular, and systemic features were analyzed.Results: In the 78 cases, the mean tear positivity was 26.92% (21/78), 2 tear samples being positive despite a negative NP swab. The mean Ct value of tears and NP were 28.17 ± 4.76 and 23.71 ± 6.19, respectively (p= .003). None of the cases had ocular findings or relationship between tear positivity and comorbidity.Conclusions: The viral load of tears is less than the NP secretions with the possibility of prolonged shedding in tears. Tears act as an additional source of contact transmission in ICU that can possibly be decreased by frequent hand hygiene by the patient.Abbreviations: SARS-CoV-2: Severe acute respiratory syndrome coronavirus; RT-PCR: Real-time Reverse transcriptase-polymerase chain reaction; COVID-19: Corona virus disease 2019; ICU: Intensive care unit; RdRp: RNA-dependent RNA polymerase; ORF 1b: Open reading frame 1b; AIIR: Airborne infection isolation room; HCW: Health care workers; VTM: viral transport media; NP: Nasopharyngeal swab; PPE: Personal protective equipment.
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Affiliation(s)
- Ritu Arora
- Department of Ophthalmology (Guru Nanak Eye Centre), Maulana Azad Medical College, New Delhi, India
| | - Ruchi Goel
- Department of Ophthalmology (Guru Nanak Eye Centre), Maulana Azad Medical College, New Delhi, India
| | - Sonal Saxena
- Department of Microbiology, Maulana Azad Medical College, New Delhi, India
| | - Vikas Manchanda
- Department of Microbiology, Maulana Azad Medical College, New Delhi, India
| | | | - Gaurav Gupta
- NPO (Injury and Disability Prevention), WHO, India
| | - Mohit Chhabra
- Department of Ophthalmology (Guru Nanak Eye Centre), Maulana Azad Medical College, New Delhi, India
| | - Sumit Kumar
- Department of Ophthalmology (Guru Nanak Eye Centre), Maulana Azad Medical College, New Delhi, India
| | | | - Payden
- Deputy Country Head, WHO, India
| | - Palak Pumma
- Department of Microbiology, Maulana Azad Medical College, New Delhi, India
| | - Kirti Saxena
- Department of Anaesthesiology, Maulana Azad Medical College, New Delhi, India
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Mardian Y, Kosasih H, Karyana M, Neal A, Lau CY. Review of Current COVID-19 Diagnostics and Opportunities for Further Development. Front Med (Lausanne) 2021; 8:615099. [PMID: 34026773 PMCID: PMC8138031 DOI: 10.3389/fmed.2021.615099] [Citation(s) in RCA: 79] [Impact Index Per Article: 26.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2020] [Accepted: 04/06/2021] [Indexed: 12/15/2022] Open
Abstract
Diagnostic testing plays a critical role in addressing the coronavirus disease 2019 (COVID-19) pandemic, caused by Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2). Rapid and accurate diagnostic tests are imperative for identifying and managing infected individuals, contact tracing, epidemiologic characterization, and public health decision making. Laboratory testing may be performed based on symptomatic presentation or for screening of asymptomatic people. Confirmation of SARS-CoV-2 infection is typically by nucleic acid amplification tests (NAAT), which requires specialized equipment and training and may be particularly challenging in resource-limited settings. NAAT may give false-negative results due to timing of sample collection relative to infection, improper sampling of respiratory specimens, inadequate preservation of samples, and technical limitations; false-positives may occur due to technical errors, particularly contamination during the manual real-time polymerase chain reaction (RT-PCR) process. Thus, clinical presentation, contact history and contemporary phyloepidemiology must be considered when interpreting results. Several sample-to-answer platforms, including high-throughput systems and Point of Care (PoC) assays, have been developed to increase testing capacity and decrease technical errors. Alternatives to RT-PCR assay, such as other RNA detection methods and antigen tests may be appropriate for certain situations, such as resource-limited settings. While sequencing is important to monitor on-going evolution of the SARS-CoV-2 genome, antibody assays are useful for epidemiologic purposes. The ever-expanding assortment of tests, with varying clinical utility, performance requirements, and limitations, merits comparative evaluation. We herein provide a comprehensive review of currently available COVID-19 diagnostics, exploring their pros and cons as well as appropriate indications. Strategies to further optimize safety, speed, and ease of SARS-CoV-2 testing without compromising accuracy are suggested. Access to scalable diagnostic tools and continued technologic advances, including machine learning and smartphone integration, will facilitate control of the current pandemic as well as preparedness for the next one.
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Affiliation(s)
- Yan Mardian
- Indonesia Research Partnership on Infectious Disease (INA-RESPOND), Jakarta, Indonesia
| | - Herman Kosasih
- Indonesia Research Partnership on Infectious Disease (INA-RESPOND), Jakarta, Indonesia
| | - Muhammad Karyana
- Indonesia Research Partnership on Infectious Disease (INA-RESPOND), Jakarta, Indonesia
- National Institute of Health Research and Development, Ministry of Health, Republic of Indonesia, Jakarta, Indonesia
| | - Aaron Neal
- National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD, United States
| | - Chuen-Yen Lau
- National Cancer Institute, National Institutes of Health, Bethesda, MD, United States
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Gandhi A, Naik M, Narula A. Ophthalmological manifestations of COVID-19 and its transmissibility via ocular route. Postgrad Med J 2021; 97:329. [PMID: 32554446 DOI: 10.1136/postgradmedj-2020-138069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/01/2020] [Indexed: 01/14/2023]
Affiliation(s)
- Aastha Gandhi
- Ophthalmology, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, India
| | - Mayuresh Naik
- Ophthalmology, Hamdard Institute of Medical Science and Research, New Delhi, India
| | - Anurag Narula
- Ophthalmology, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, India
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Sopp NM, Sharda V. An Eye on COVID-19: A Meta-analysis of Positive Conjunctival Reverse Transcriptase-Polymerase Chain Reaction and SARS-CoV-2 Conjunctivitis Prevalence. Optom Vis Sci 2021; 98:429-436. [PMID: 33973912 PMCID: PMC8136458 DOI: 10.1097/opx.0000000000001687] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2020] [Accepted: 01/30/2021] [Indexed: 01/08/2023] Open
Abstract
SIGNIFICANCE This analysis and review demonstrate that, although emerging data indicate that the prevalence of severe acute respiratory coronavirus 2 (SARS-CoV-2) on the ocular surface and coronavirus disease 2019 (COVID-19) conjunctivitis is rare, the ocular surface remains of interest as a potential inoculation and transmission site for SARS-CoV-2. Continued safety precautions should be taken as more data become available.COVID-19, caused by SARS-CoV-2, is a novel, global pandemic that has infected millions and, up to this point, caused more than two million fatalities worldwide. The ocular surface has become of interest as a possible vector for transmission by acting as a direct inoculation site, being a conduit for the virus into the respiratory system or as a method of transmission from potentially infected conjunctiva or tears. The components necessary for SARS-CoV-2 to theoretically infect ocular tissues are present: binding receptors (angiotensin-converting enzyme 2 and cluster of differentiation 147) and mechanisms for cell entry (transmembrane protease serine 2 and cathepsin L). This meta-analysis of COVID-19 prevalence data indicates that SARS-CoV-2 RNA has been infrequently found in conjunctival samples when tested with reverse transcriptase-polymerase chain reaction. This review estimates the prevalence of SARS-CoV-2 on the ocular surface and prevalence of conjunctivitis in patients with laboratory-confirmed COVID-19. There is much to be learned regarding ocular tropism of SARS-CoV-2.
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Paul A, Sainath D, Srikanth K, Vallinayagam M. Awareness of COVID-19-related ocular symptoms in a tertiary health care hospital. Indian J Ophthalmol 2021; 69:1001-1002. [PMID: 33727482 PMCID: PMC8012918 DOI: 10.4103/ijo.ijo_3282_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Affiliation(s)
- Anujeet Paul
- Department of Ophthalmology, Mahatma Gandhi Medical College and Research Institute, Sri Balaji Vidyapeeth, Pondicherry, India
| | - Dipika Sainath
- Department of Ophthalmology, Mahatma Gandhi Medical College and Research Institute, Sri Balaji Vidyapeeth, Pondicherry, India
| | - Krishnagopal Srikanth
- Department of Ophthalmology, Mahatma Gandhi Medical College and Research Institute, Sri Balaji Vidyapeeth, Pondicherry, India
| | - Muthukrishnan Vallinayagam
- Department of Ophthalmology, Mahatma Gandhi Medical College and Research Institute, Sri Balaji Vidyapeeth, Pondicherry, India
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