Impact of COVID-19 on ophthalmic surgical procedures in sub-Saharan Africa: a multicentre study

BACKGROUND

The COVID-19 pandemic had a profound impact on healthcare and ophthalmology services globally. Numerous studies amongst various medical and surgical specialties showed a reduction in patient attendance and surgical procedures performed. Prior published ophthalmic literature focused on specific types of procedures and were usually single centre. The current study attempts to quantify the impact on a larger scale, namely that of sub-Saharan Africa, and to include all ophthalmic subspecialties.

METHODS

This is a retrospective analysis of the surgical records from 17 ophthalmology centres in seven countries located in East, Central, West and Southern Africa. The date of declaration of the first lockdown was used as the beginning of the pandemic and the pivot point to compare theatre records one year prior to the pandemic and the first year of the pandemic. We examined the total number of surgical procedures over the two year period and categorized them according to ophthalmic subspecialty and type of procedure performed. We then compared the pre-pandemic and pandemic surgical numbers over the two year period.

RESULTS

There were 26,357 ophthalmic surgical procedures performed with a significant decrease in the first year of the pandemic (n = 8942) compared to the year prior to the pandemic (n = 17,415). The number of surgical procedures performed was lower in the first year of the pandemic compared to the year prior to the pandemic by 49% [Incidence rate ratio (IRR) 0.51, 95% CI 0.41-0.64), 27% (0.73, 0.55-0.99), 46% (0.54, 0.30-0.99), 40% (0.60, 0.39-0.92) and 59% (0.41, 0.29-0.57) in sub-Saharan Africa (4 regions combined), West, Central, East and Southern Africa, respectively]. The number of surgical procedures in the different sub-specialty categories in sub-Saharan Africa (4 regions combined) was significantly lower in the first year of the pandemic compared to the year prior to the pandemic, except for glaucoma (IRR 0.72, 95% CI 0.52-1.01), oncology (0.71, 0.48-1.05), trauma (0.90, 0.63-1.28) and vitreoretinal (0.67, 0.42-1.08) categories.

CONCLUSION

This study provides insight into the impact of the COVID-19 pandemic in multiple regions and countries on the African continent. The identification of which surgical subspecialty was most affected by the COVID-19 pandemic in each region allows for better planning and resource allocation to address these backlogs.

Subjective integration and quality of life of Sub-Saharan African migrants in Germany

OBJECTIVE

This article presents empirical evidence on the quality of life (QoL) of Sub-Saharan African (SSA) migrants in Germany, exploring its association with subjective integration and the influence of some socio-economic and sociodemographic characteristics.

STUDY DESIGN

This is a cross-sectional study design using quantitative data from 518 SSA migrants collected across the 16 federal states of Germany, and these data were analysed in this study.

METHODS

Association between participants' QoL, measured by the four domains of the Bref version of the World Health Organisation QoL measure, subjective integration and sociodemographic characteristics were evaluated using Pearson product-moment correlations. Stepwise multiple linear regressions were performed to explore the contribution of predictor variables on the QoL domain.

RESULTS

Participants' age averaged 32.5 years (standard deviation [SD] 7.93). The sample reported a low QoL score with a mean score of 64.3 (SD 14.4, range 70.2). Multiple linear regression analyses revealed that subjective integration, age, education and gender had significant associations and explained up to 27% of the variance in the QoL domain scores.

CONCLUSION

The findings of this study support the conclusion that subjective integration positively and significantly associates with the physical health, psychological health, social relationships and environmental domains of SSA migrants' QoL in Germany.

Pharmacokinetics and antinociceptive effects of the soluble epoxide hydrolase inhibitor t-TUCB in horses with experimentally induced radiocarpal synovitis

This study determined the pharmacokinetics, antinociceptive, and anti-inflammatory effects of the soluble epoxide hydrolase (sEH) inhibitor t-TUCB (trans-4-{4-[3-(4-Trifluoromethoxy-phenyl)-ureido]-cyclohexyloxy}-benzoic acid) in horses with lipopolysaccharide (LPS)-induced radiocarpal synovitis. A total of seven adult healthy mares (n = 4-6/treatment) were administered 3 μg LPS into one radiocarpal joint and t-TUCB intravenously (i.v.) at 0 (control), 0.03, 0.1, 0.3, and 1 mg/kg in a blinded, randomized, crossover design with at least 3 weeks washout between. Two investigators independently assigned pain scores (at rest, walk and trot) and lameness scores before and up to 48 hr after t-TUCB/LPS. Responses to touching the joint skin to assess tactile allodynia, plasma, and synovial fluid (SF) t-TUCB concentrations were determined before and up to 48 hr after t-TUCB/LPS. Blood and SF were collected for clinical laboratory evaluations before and up to 48 hr after t-TUCB/LPS. Areas under the curves of pain and lameness scores were calculated and compared between control and treatments. Data were analyzed using repeated measures ANOVA with Dunnett or Bonferroni post-test. p < .05 was considered significant. Data are mean ± SEM. Compared to control, pain, lameness, and tactile allodynia were significantly lower with 1 mg/kg t-TUCB, but not the other doses. For 0.1, 0.3, and 1 mg/kg t-TUCB treatments, plasma terminal half-lives were 13 ± 3, 13 ± 0.5, and 24 ± 5 hr, and clearances were 68 ± 15, 48 ± 5, and 14 ± 1 ml hr^-1  kg^-1 . The 1 mg/kg t-TUCB reached the SF at high concentrations. There were no important anti-inflammatory effects. In conclusion, sEH inhibition with t-TUCB may provide analgesia in horses with inflammatory joint pain.

MRSA in children presenting to hospitals in Birmingham, UK

Meticillin-resistant Staphylococcus aureus (MRSA) isolates from children presenting to Birmingham hospitals were characterized using molecular methods. The study was performed on MRSA isolates from children aged </=16 years, identified between March 2004 and December 2004, from three hospitals offering general paediatric services. Fifty isolates were classified as either community-acquired (CA-MRSA) or hospital-acquired MRSA (HA-MRSA) according to Centers for Disease Control and Prevention (CDC) criteria. They underwent susceptibility testing and pulsed-field gel electrophoresis (PFGE) analyses. Polymerase chain reaction (PCR) methodology was used to determine the type of staphylococcal chromosome cassette (SCCmec) and the presence or absence of genes encoding Panton-Valentine leucocidin (PVL). Overall, 31 (62%) MRSA were defined as CA-MRSA. PFGE band pattern and SCCmec analysis were similar to EMRSA 15 for 72% of isolates. Over 80% of isolates contained SCCmec type IV; one isolate was untypable. Genes encoding PVL were not detected. MRSA in children presenting to Birmingham hospitals classified as CA-MRSA are most likely to resemble the usual hospital epidemic strains. None of the isolates fulfilled the criteria for de-novo CA-MRSA based on PFGE, PVL production and SCCmec analysis.

MRSA at an English children's hospital from 1998 to 2003

AIMS

To investigate the epidemiological and clinical aspects of MRSA among inpatients and outpatients presenting to hospital.

METHODS

Analysis of demographic, epidemiological, and clinical data collected on 385 children first identified as having MRSA between January 1998 and December 2003 in a 250 bed English children's hospital.

RESULTS

There were 267 inpatients and 118 outpatients. The number of new cases of MRSA declined from 72 in 1998 to 52 in 2003, whereas hospital activity increased. Ninety nine (37.1%) inpatients acquired MRSA outside the hospital; a further 90 occurred among 31 clusters of cases. One hundred and seventy eight (66.7%) inpatients were aged <2 years; cardiac services and paediatric & neonatal surgery accounted for 59.6% of cases. Dermatology and A&E accounted for 51.7% of outpatients; 73.8% of outpatients had recently previously attended the hospital. A total of 13.9% of inpatients with MRSA developed bacteraemia; MRSA accounted for 15% of Staphylococcus aureus bacteraemias. The risk of MRSA bacteraemia in colonised patients, and the proportion of S aureus bacteraemias that were MRSA, varied between specialties. Intravascular devices were the most common source of MRSA bacteraemia (63.4% of cases). The mortality rate was 7.3%.

CONCLUSIONS

Enhanced surveillance of MRSA can identify at-risk patient groups, thus facilitating targeting of control measures. The absence of a link between numbers of cases of acquisition of MRSA and bacteraemia suggests that the rise in MRSA bacteraemia may not solely reflect an increase in MRSA prevalence in children in the UK. The need for larger epidemiological studies is emphasised.

Per anal excision of large rectal adenomas using an endoscopic stapler

Large rectal adenomas can be approached per-anally by open excision or by transanal endoscopic microsurgery (TEMS). We describe the adaptation of an endoscopic linear stapler-cutter for per anal excision of rectal polyps. It can be used for difficult polyps with minimal risk of complications and is easier and more accessible than TEMS.

Analgesic activity of Peperomia pellucida aerial parts in mice

The methanol extract of Peperomia pellucida aerial parts, given orally at doses ranging from 70 to 210 mg/kg, showed a significant analgesic activity on acetic acid-induced writhing in mice.

Intestinal obstruction in Nigerian children

A 10-yr review of acute intestinal obstruction in 280 Nigerian children reveals that the condition is the major cause of surgical emergencies in Nigerian children, as in children of other developing countries. These are significant differences of pediatric intestinal obstruction in developing countries, as compared with the pattern in other parts of the world. Intussuscaption was the leading cause followed by incarcerated or strangulated hernia. Lateness in presentation was common, with a resulting high morbidity and prolonged hospital stay. The overall mortality was 16%, but mortality of 33% was recorded in the neonatal group.