Gender differences in the surgical management of trachomatous trichiasis: an exploratory analysis of global trachoma survey data, 2015-2019

BACKGROUND

Trachomatous trichiasis (TT) is a painful, potentially blinding eye condition that can be managed through epilation or surgery. Women are affected by TT approximately twice as often as men and are believed to face gendered barriers to receiving surgical care to prevent vision loss.

METHODS

We used data from 817 cross-sectional surveys conducted during 2015-2019 in 20 African countries to estimate the prevalence difference (PD) between female and male eyes for four outcomes potentially indicating gender-related differences in TT management: (1) received surgery and developed postoperative TT (PTT), (2) never offered surgery, (3) offered surgery but declined it, and (4) offered epilation but never offered surgery.

RESULTS

The prevalence was modestly elevated among female eyes compared with male eyes for having PTT (PD:1.8 [95% confidence limits (CL): 0.6, 3.0]) and having declined surgery for the eye (PD: 6.2 [95% CL: 1.8, 10.7]). The proportion offered epilation was similar by gender (PD:0.5 [95% CL: -0.4, 1.3]), while never having been offered surgery was somewhat more prevalent among male eyes (PD: -2.1 [95% CL: -3.5, -0.7]).

CONCLUSIONS

Our results suggest potential gender differences in TT management. More research is needed to determine the causes and implications of the observed differences.

Tropical Data: Approach and Methodology as Applied to Trachoma Prevalence Surveys

PURPOSE

Population-based prevalence surveys are essential for decision-making on interventions to achieve trachoma elimination as a public health problem. This paper outlines the methodologies of Tropical Data, which supports work to undertake those surveys.

METHODS

Tropical Data is a consortium of partners that supports health ministries worldwide to conduct globally standardised prevalence surveys that conform to World Health Organization recommendations. Founding principles are health ministry ownership, partnership and collaboration, and quality assurance and quality control at every step of the survey process. Support covers survey planning, survey design, training, electronic data collection and fieldwork, and data management, analysis and dissemination. Methods are adapted to meet local context and needs. Customisations, operational research and integration of other diseases into routine trachoma surveys have also been supported.

RESULTS

Between 29th February 2016 and 24th April 2023, 3373 trachoma surveys across 50 countries have been supported, resulting in 10,818,502 people being examined for trachoma.

CONCLUSION

This health ministry-led, standardised approach, with support from the start to the end of the survey process, has helped all trachoma elimination stakeholders to know where interventions are needed, where interventions can be stopped, and when elimination as a public health problem has been achieved. Flexibility to meet specific country contexts, adaptation to changes in global guidance and adjustments in response to user feedback have facilitated innovation in evidence-based methodologies, and supported health ministries to strive for global disease control targets.

Evaluation of the Performance of a 3D-Printed Smartphone-Based Retinal Imaging Device as a Screening Tool for Retinal Pathology in Mozambique

Low-income countries carry approximately 90% of the global burden of visual impairment, and up to 80% of this could be prevented or cured. However, there are only a few studies on the prevalence of retinal disease in these countries. Easier access to retinal information would allow differential diagnosis and promote strategies to improve eye health, which are currently scarce. This pilot study aims to evaluate the functionality and usability of a tele-retinography system for the detection of retinal pathology, based on a low-cost portable retinal scanner, manufactured with 3D printing and controlled by a mobile phone with an application designed ad hoc. The study was conducted at the Manhiça Rural Hospital in Mozambique. General practitioners, with no specific knowledge of ophthalmology or previous use of retinography, performed digital retinographies on 104 hospitalized patients. The retinographies were acquired in video format, uploaded to a web platform, and reviewed centrally by two ophthalmologists, analyzing the image quality and the presence of retinal lesions. In our sample there was a high proportion of exudates and hemorrhages-8% and 4%, respectively. In addition, the presence of lesions was studied in patients with known underlying risk factors for retinal disease, such as HIV, diabetes, and/or hypertension. Our tele-retinography system based on a smartphone coupled with a simple and low-cost 3D printed device is easy to use by healthcare personnel without specialized ophthalmological knowledge and could be applied for the screening and initial diagnosis of retinal pathology.

Exploring water, sanitation, and hygiene coverage targets for reaching and sustaining trachoma elimination: G-computation analysis

BACKGROUND

Trachoma is the leading infectious cause of blindness. To reduce transmission, water, sanitation, and hygiene (WaSH) improvements are promoted through a comprehensive public health strategy. Evidence supporting the role of WaSH in trachoma elimination is mixed and it remains unknown what WaSH coverages are needed to effectively reduce transmission.

METHODS/FINDINGS

We used g-computation to estimate the impact on the prevalence of trachomatous inflammation-follicular among children aged 1-9 years (TF1-9) when hypothetical WaSH interventions raised the minimum coverages from 5% to 100% for "nearby" face-washing water (<30 minutes roundtrip collection time) and adult latrine use in an evaluation unit (EU). For each scenario, we estimated the generalized prevalence difference as the TF1-9 prevalence under the intervention scenarios minus the observed prevalence. Data from 574 cross-sectional surveys conducted in 16 African and Eastern Mediterranean countries were included. Surveys were conducted from 2015-2019 with support from the Global Trachoma Mapping Project and Tropical Data. When modeling interventions among EUs that had not yet met the TF1-9 elimination target, increasing nearby face-washing water and latrine use coverages above 30% was generally associated with consistent decreases in TF1-9. For nearby face-washing water, we estimated a ≥25% decrease in TF1-9 at 65% coverage, with a plateau upon reaching 85% coverage. For latrine use, the estimated decrease in TF1-9 accelerated from 80% coverage upward, with a ≥25% decrease in TF1-9 by 85% coverage. Among EUs that had previously met the elimination target, results were inconclusive.

CONCLUSIONS

Our results support Sustainable Development Goal 6 and provide insight into potential WaSH-related coverage targets for trachoma elimination. Targets can be tested in future trials to improve evidence-based WaSH guidance for trachoma.

AB0570 CLINICAL AND IMMUNOLOGICAL MANIFESTATIONS IN SLE PATIENTS IN A THIRD LEVEL HOSPITAL IN ROSARIO, ARGENTINA

Background

Systemic lupus erythematosus (SLE) is a chronic and complex inflammatory disease which predominantly affects young females during reproductive ages. Its prognosis is worse in males, young people, Afro-American and Latin patients. Clinical and immunological features had been described around the world but few reports had been done in Argentinian patients.

Objectives

The purpose of this study was to describe the clinical and immunological pattern in SLE patients, characteristics of lupus nephritis (LN), disease male’s course of SLE, treatments and causes of hospitalization.

Methods

Retrospective study including patients (>18 years) followed in Rheumatology Department, which had unless two visits in the last year before data collection, its clinical reports were complete, and fulfilled SLICC or EULAR/ACR SLE criteria. We recorded data from the medical reports.

Results

Of the 70 patients, 63 were female (90%). The mean age at diagnosis was 27,86 ± 9,4 years. The most frequent manifestations were arthritis (75,7%), malar rash (65,7%), photosensitivity (31,4%), leukopenia (31,4%), alopecia (31,4%), Raynaud’s phenomenon (24,3%) and nasal and oral ulcerations (21,4%).

94,3% of patients were positive for antinuclear antibodies, 45,7% had anti-Ro/SSa, 28,6% anti-RNP and 21% anti-Smith. 75% had low complement and 45,7% anti-DNA antibodies.

LN occurred in the 50% of patients, and class IV was the most prevalent in this group. 66% of patients developed LN in the first year of SLE diagnosis. Autoantibodies in this manifestation were: anti-DNA 60%, anti-Ro/SSa 37%, 31% anti-RNP and 26% anti-Smith.

The most common comorbidity was high blood pressure followed by hypothyroidism (34,3% and 25,7% respectively). All patients received hydroxychloroquine and 62,9% prednisone; half of the patients who were into prednisone treatment received 5mg or less. Other treatments were cyclophosphamide (42,9%), mycophenolate (28,6%) and methotrexate (15,7%). 60% of patients had been hospitalized because of SLE flares and 15,7% due to infections. 75% of flares were due to LN and 8% because of serositis.

Is known that SLE in male patients is more aggressive and with poor prognosis. Although this study had only 7 men, 86% had LN, 29% had pericardial and pleural effusion and 29% thrombocytopenia, were we found several differences in female’s SLE presentation.

Conclusion

This study shown similar results reported in other populations. We found that 50% of SLE patients developed LN, which is the most important cause of hospitalization. Although cutaneous and musculoskeletal manifestations were the most frequent, it’s important to take into account the clinical and prognostic differences between male and female.

References

[1]Pons Estel B et al. The GLADEL, multinational Latin American prospective inception cohort of 1214 patients with systemic lupus erythematosus: ethnic and disease heterogeneity among Hispanics. Medicine 2004;83;1-17

[2]Alarcón GS, Friedman AW, Straaton KV, et al. Systemic lupus erythematosus in three ethnic groups: III. A comparison of characteristics early in the natural history of the LUMINA cohort. LUpus in MInority populations: NAture vs. Nurture. Lupus 1999;8:197–209

[3]Aringer M et al. 2019 European League Against Rheumatism/American College of Rheumatology Classification Criteria for Systemic Lupus Erythematosus. Arthritis & Rheumatology. 2019;71;1400-1412

[4]Cervera R et al. Morbidity and mortality in systemic lupus erythematosus during a 10-year period. Medicine 2003; 82: 299-308

Disclosure of Interests

None declared

AB0389 EVOLUTION OF MONOTHERAPY IN RHEUMATOID ARTHRITIS: IMPACT OF THE RISE OF JAK INHIBITOR

Background

According to different international registries, the frequency of use of biological agents in monotherapy in RA ranges from 12 to 39%. Targeted synthetic DMARDs (tsDMARDs-Jaki) have shown great efficacy when used as monotherapy. The rationale for this study is based on the fact that the frequency has increased with the appearance of the Jaki.

Objectives

To estimate the frequency and reason of the use of biological drugs (bDMARDs) or tsDMARDs in monotherapy since 2013 (Year the Jaki were available in Argentina). To describe the frequency of monotherapy by treatment class and analyze the differential characteristics.

Methods

Retrospective and cross-sectional multicenter study (10 reference centers from Argentina). Consecutive patients, ≥18 years, diagnosis of RA (ACR / EULAR 2010), who were under treatment with bDMARDs or tsDMARDs, started after 2013. Socio-demographic, disease and therapeutic data were collected.

Statistical analysis

descriptive statistics, Chi2 test, Fisher’s exact test, Student’s T test and Mann Whitney were performed, according to the nature of the variables. A p <0.05 was considered significant.

Results

Total 505 patients were included, 87.7% women, with a mean age 58 years (SD ± 13.5) and disease duration of 13 years (SD ± 7.8). Treatment: TNF blocker 42.1%, JAKi 30.3%, IL-6 blocker 10.9% and other treatments 16.8%.

Since 2013, the frequency of monotherapy was 49% (95% CI: 45-53), in the last visit the current frequency was 41% (95% CI 37-45),of this 40% received JAKi. JAKi and IL-6 blocker were the treatments that were used more frequently in monotherapy vs combination modality (Figure 1).

Figure 1.

The main causes of monotherapy were intolerance (39.9%), adverse event (22%), physician’s decision (20.2%) and lack of adherence (17.7%) to DMARDs. Patients who were active workers (64% vs 55%, p <0.05), with higher socioeconomic status (31.4% vs 17.2% p <0.01), better mean HAQ at diagnosis (1.1 vs 1.3, p <0.05) an association was observed with monotherapy. In addition, an association was observed with the use of monotherapy in patients in the 2nd biological line or higher vs 1st line (53% vs 33%, p <0.01), lower polypharmacy (45.6% vs 60%, p <0.02) and a shorter mean time of biological treatment (47 months vs 39 months, p <0.01). These variables were entered in a logistic regression model, the results of the independently associated variables are shown in Table 1.

Table 1.VariablepORCI 95%Employment status (active).0,1911,3270,8682,029Socioeconomic level (medium-high stratum)0,0022,151,3233,494HAQ at diagnosis, M (SD)0,0190,7040,5240,944First Line of biological treatment or Jaki (yes)0,020,4590,30,7Polypharmacy (>4 drugs) (yes)0,0180,6030,3950,918bDMARDs or tsDMARDs exposure time (months)0,0540,9940,9871

Conclusion

The frequency of monotherapy, since the Jaki’s emergence, was 49% (all follow-up) and 41% (current-last visit). Intolerance to cDMARDs doctor and the patient decision were the main cause. The monotherapy use pattern was greater in those who received JAKi and anti IL6. The use of monotherapy was associated with work activity, socioeconomic status, and functional capacity at diagnosis. An association was also observed with less polypharmacy.

References

[1]Smolen JS, et al. Ann Rheum Dis 2020;79:685–699.

[2]Emery P, Sebba A, Huizinga TW. Ann Rheum Dis.2013;72(12):1897–904.

[3]F. Sommerfleck et al. Rev Arg Reumatol. 2013;24(4): 30-36

[4]Aletaha D, Neogi T, Silman AJ,et al. Arthritis Rheum 2010. 2010;62(9):2569–81.

Disclosure of Interests

Rodrigo Garcia Salinas Speakers bureau: Abbvie, Lilly, BMS, Jassen, Novartis, boehringer ingelheim, Consultant of: Lilly, Jassen, Grant/research support from: Abbvie, Fernando Sommerfleck Speakers bureau: Abbvie, Janssen, Novartis, Grant/research support from: Abbvie, Alfredo Vargas Caselles: None declared, Luis Palomino Romero: None declared, Javier Rosa: None declared, Mariana Benegas: None declared, Etel Saturansky: None declared, Pamela Giorgis: None declared, Florencia Martinez: None declared, Marcelo Abdala: None declared, Jimena Sanchez Alcover: None declared, Emma Estela Civit De Garignani: None declared, Gabriela Vanesa Espasa: None declared, Verónica Inés Bellomio: None declared, Juan Manuel Bande: None declared, Silvia Papasidero: None declared, Veronica Saurit: None declared, Leticia Ibañez Zurlo: None declared, Emilio Buschiazzo: None declared

AB1358 AN OLD METHOD FOR CURRENT CHALLENGES: SKIN TEST CONVERSION OF PURIFIED PROTEIN DERIVATIVE (PPD) IN RHEUMATOLOGICAL PATIENTS TREATED WITH ANTI-TNF-α

Background

Anti-TNF-α are a cornerstone for the treatment of multiple rheumatic diseases. They are associated with an increased risk of developing tuberculosis (TB), which is endemic in several countries and an important burden across the globe. Purified protein derivative (PPD) is one of the tests used to demonstrate a latent TB infection (LTBI). Screening is recommended for TB prior to the onset of anti-TNF-α and monitoring evaluating possible conversion of PPD during treatment, defined as the change from a negative (<5 mm) to positive result (≥5 mm). Identification and treatment of LTBI can reduce the risk of disease development by up to 90%. Currently the results of PPD conversion and its interpretation during anti-TNF-α treatment are variable and that is why we set out to know the frequency of conversion of PPD in this group of patients in our environment.

Objectives

To identify PPD conversion in patients with rheumatological diseases undergoing anti-TNF-α treatment.

Methods

A descriptive, analytical, observational, retrospective study was conducted from January 1, 2018 to January 1, 2022. Inclusion criteria: Patients >18 years old, diagnosed with rheumatological diseases and treated with anti-TNF-α for more than 3 consecutive months, with a negative PPD (<5 mm diameter) previous starting anti-TNF-α and a normal chest X-ray.

Results

62 patients (age 45.8 ± 12.5 years), with rheumatological diseases (41 rheumatoid arthritis, 7 juvenile idiopathic arthritis, 5 ankylosing spondylitis, 4 psoriatic arthritis, 4 uveitis and 1 interstitial keratitis) under anti-TNF-α therapy (35 adalimumab, 18 certolizumab, 9 etanercept) were included. Concomitant use of immunomodulators (52 methotrexate, 23 leflunomide, 10 hidroxicloroquine, 3 sulfasalazine, 2 azathioprine and 1 mycophenolate mofetil) and glucocorticoids (33/62) was observed. The conversion of PPD took place in 4 patients (6.5%) (Table 1).

Table 1.

“Patient’s characteristics”

SexAgeRDanti-TNF-αTime doing anti-TNF-αDMARDGCSPPDChest X-rayTB prophylaxis1Male66PsAadalimumab6 yearsmethotrexateNo5 mmNormalIsoniazid2Female56RAadalimumab10 yearsmethotrexateNo5 mmNormalIsoniazid3Female62RAadalimumab5 yearsmethotrexateYes10 mmNormalIsoniazid4Male45AScertolizumab1 yearNoNo20 mmNormalIsoniazid

AS, ankylosing spondylitis; DMARD, disease-modifying antirheumatic drugs; GCS, glucocorticosteroids; PPD, purified protein derivative; PsA, psoriatic arthritis; RA, rheumatoid arthritis; RD, rheumatological disease; TB, tuberculosis.

Conclusion

Considering the prevalence of TB in our country, this research showed a lower PPD conversion percentage compared to previous reports. Anti-TNF-α have radically changed the evolution of rheumatological diseases, considerably improving the patient’s quality of life. With the increase in the accessibility of anti-TNF-α worldwide, new challenges have arisen regarding infectious diseases such as TB, which is endemic in some countries. PPD is a well known, cheap, sensitive and widely available method, suitable for LTBI diagnosis. Although sensitivity could be increased using, in addition, other LTBI detection methods such as IGRAs (interferon gamma release assays), they are usually unavailable in developing countries (1-3).

References

[1]Lewinsohn DM, Leonard MK, LoBue PA, et al. Official American Thoracic Society/Infectious Diseases Society of America/Centers for Disease Control and Prevention Clinical Practice Guidelines: Diagnosis of Tuberculosis in Adults and Children. Clin Infect Dis 2017; 64(2):e1-e33.

[2]Cerda O, Correa M, Granel A, Marcos A, Giraldo C, Rillo O et al. Tuberculin test conversion in patients with chronic inflammatory arthritis receiving biological therapy. European Journal of Rheumatology. 2019;6(1):19-22

[3]Busquets-Pérez N, Ponce A, Ortiz-Santamaria V, de Agustín de Oro J, Hernández-Rico Y, Vidal I et al. How many patients with rheumatic diseases and TNF inhibitors treatment have latent tuberculosis? 2020; 13(5):282-286.

Disclosure of Interests

None declared

Estimating the Intracluster Correlation Coefficient for the Clinical Sign "Trachomatous Inflammation-Follicular" in Population-Based Trachoma Prevalence Surveys: Results From a Meta-Regression Analysis of 261 Standardized Preintervention Surveys Carried Out in Ethiopia, Mozambique, and Nigeria

Sample sizes in cluster surveys must be greater than those in surveys using simple random sampling in order to obtain similarly precise prevalence estimates, because results from subjects examined in the same cluster cannot be assumed to be independent. Therefore, a crucial aspect of cluster sampling is estimation of the intracluster correlation coefficient (ρ): the degree of relatedness of outcomes in a given cluster, defined as the proportion of total variance accounted for by between-cluster variation. In infectious disease epidemiology, this coefficient is related to transmission patterns and the natural history of infection; its value also depends on particulars of survey design. Estimation of ρ is often difficult due to the lack of comparable survey data with which to calculate summary estimates. Here we use a parametric bootstrap model to estimate ρ for the ocular clinical sign “trachomatous inflammation—follicular” (TF) among children aged 1–9 years within population-based trachoma prevalence surveys. We present results from a meta-regression analysis of data from 261 such surveys completed using standardized methods in Ethiopia, Mozambique, and Nigeria in 2012–2015. Consistent with the underlying theory, we found that ρ increased with increasing overall TF prevalence and smaller numbers of children examined per cluster. Estimates of ρ for TF were independently higher in Ethiopia than in the other countries.

The global burden of trichiasis in 2016

Background

Trichiasis is present when one or more eyelashes touches the eye. Uncorrected, it can cause blindness. Accurate estimates of numbers affected, and their geographical distribution, help guide resource allocation.

Methods

We obtained district-level trichiasis prevalence estimates in adults for 44 endemic and previously-endemic countries. We used (1) the most recent data for a district, if more than one estimate was available; (2) age- and sex-standardized corrections of historic estimates, where raw data were available; (3) historic estimates adjusted using a mean adjustment factor for districts where raw data were unavailable; and (4) expert assessment of available data for districts for which no prevalence estimates were available.

Findings

Internally age- and sex-standardized data represented 1,355 districts and contributed 662 thousand cases (95% confidence interval [CI] 324 thousand–1.1 million) to the global total. Age- and sex-standardized district-level prevalence estimates differed from raw estimates by a mean factor of 0.45 (range 0.03–2.28). Previously non- stratified estimates for 398 districts, adjusted by ×0.45, contributed a further 411 thousand cases (95% CI 283–557 thousand). Eight countries retained previous estimates, contributing 848 thousand cases (95% CI 225 thousand-1.7 million). New expert assessments in 14 countries contributed 862 thousand cases (95% CI 228 thousand–1.7 million). The global trichiasis burden in 2016 was 2.8 million cases (95% CI 1.1–5.2 million).

Interpretation

The 2016 estimate is lower than previous estimates, probably due to more and better data; scale-up of trichiasis management services; and reductions in incidence due to lower active trachoma prevalence.

As an individual with trichiasis blinks, the eyelashes abrade the cornea, which can lead to corneal opacity and blindness. Through high quality surgery, which involves altering the position of the eyelid margin, it is possible to reduce the number of people with trichiasis. Accurate estimates of the number of persons with trichiasis and their geographical distribution are needed in order to effectively align resources for surgery and other necessary services. We obtained district-level trichiasis prevalence estimates for 44 endemic and previously-endemic countries. We used the most recently available data and expert assessments to estimate the global burden of trichiasis. We estimated that in 2016 the global burden was 2.8 million cases (95% CI 1.1–5.2 million).

The 2016 estimate is lower than previous estimates, probably due to more and better data; scale-up of trichiasis management services; and reductions in incidence due to lower active trachoma prevalence.

Understanding the spatial distribution of trichiasis and its association with trachomatous inflammation-follicular

BACKGROUND

Whilst previous work has identified clustering of the active trachoma sign "trachomatous inflammation-follicular" (TF), there is limited understanding of the spatial structure of trachomatous trichiasis (TT), the rarer, end-stage, blinding form of disease. Here we use community-level TF prevalence, information on access to water and sanitation, and large-scale environmental and socio-economic indicators to model the spatial variation in community-level TT prevalence in Benin, Cote d'Ivoire, DRC, Guinea, Ethiopia, Malawi, Mozambique, Nigeria, Sudan and Uganda.

METHODS

We fit binomial mixed models, with community-level random effects, separately for each country. In countries where spatial correlation was detected through a semi-variogram diagnostic check we then fitted a geostatistical model to the TT prevalence data including TF prevalence as an explanatory variable.

RESULTS

The estimated regression relationship between community-level TF and TT was significant in eight countries. We estimate that a 10% increase in community-level TF prevalence leads to an increase in the odds for TT ranging from 20 to 86% when accounting for additional covariates.

CONCLUSION

We find evidence of an association between TF and TT in some parts of Africa. However, our results also suggest the presence of additional, country-specific, spatial risk factors which modulate the variation in TT risk.

Strengthening the links between mapping, planning and global engagement for disease elimination: lessons learnt from trachoma

BACKGROUND

Trachoma is the leading infectious cause of blindness. Until recently, reliable data on the global extent of the disease, detailed plans for elimination, and government, donor and partner engagement were all inadequate.

METHODS

The trachoma community undertook a systematic, three-pronged strategy to map trachoma district by district, develop national-level trachoma elimination plans, and create a framework for governments, donors and partners to convene and coordinate in support of trachoma elimination.  RESULT: There has been a frame-shift in internal and external perceptions of the global trachoma programme, from being an effort working towards disease control in focussed geographical areas, to one in the process of achieving worldwide disease elimination. Multiple factors contributed to the successful implementation of mapping, planning, and cross-sectional engagement of governments, partners and donors.

CONCLUSIONS

Elimination of trachoma is possible if the right combination of factors is in place. Planning for success is a critical first step. Some remaining challenges must still be addressed if the elimination targets are to be successfully attained.

The Epidemiology of Trachoma in Mozambique: Results of 96 Population-Based Prevalence Surveys

Purpose: Surveys are needed to guide trachoma control efforts in Mozambique, with WHO guidelines for intervention based on the prevalence of trachomatous inflammation–follicular (TF) in children aged 1–9 years and the prevalence of trichiasis in adults aged 15 years and above. We conducted surveys to complete the map of trachoma prevalence in Mozambique.

Methods: Between July 2012 and May 2015, we carried out cross-sectional surveys in 96 evaluation units (EUs) covering 137 districts.

Results: A total of 269,217 individuals were enumerated and 249,318 people were examined using the WHO simplified trachoma grading system. Overall, 102,641 children aged 1–9 years, and 122,689 individuals aged 15 years and above were examined. The prevalence of TF in children aged 1–9 years was ≥10% in 12 EUs, composed of 20 districts, covering an estimated total population of 2,455,852. These districts require mass distribution of azithromycin for at least 3 years before re-survey. The TF prevalence in children was 5.0–9.9% in 17 EUs (28 districts, total population 3,753,039). 22 EUs (34 districts) had trichiasis prevalences ≥0.2% in adults 15 years and above, and will require public health action to provide surgical services addressing the backlog of trichiasis. Younger age, more children resident in the household, and living in a household that had an unimproved latrine or no latrine facility, were independently associated with an increased odds of TF in children aged 1–9 years.

Conclusions: Trachoma represents a significant public health problem in many areas of Mozambique.

Clinical, cytogenetic, and molecular testing of Argentine patients with retinoblastoma

PURPOSE

The purpose of this study is to determine the clinical, chromosomal, and molecular characteristics of Argentine patients with unilateral and bilateral retinoblastoma.

STUDY DESIGN

Eighty-six patients belonging to 82 families were studied; 59% of them were examined during the first year of life. Leukocoria was the most common reason for consultation. Other presenting signs were strabismus and glaucoma. Enucleation of the affected eye was performed in 85% of the cases and the complication rate was 13%.

RESULTS

An appropriate therapy allowed the survival of 84 of the 86 patients. Two children with malformations and growth retardation had an abnormal karyotype with a deletion in 13q14. Segregation analysis of polymorphic sites within the retinoblastoma gene and the parental origin of the allele lost in the tumor were analyzed in 30 of the 82 families. Five mutant alleles transmitted through the germline and six de novo germline mutant alleles were identified in 12 patients with hereditary retinoblastoma. Most de novo germline mutant alleles were paternally derived. Molecular analysis of nonhereditary retinoblastoma showed loss of heterozygosity in three of eight cases. From these, two maternal alleles and one paternal allele were lost, thus not indicating a significant difference in the parental origin for the lost allele.

CONCLUSIONS

These data are useful for deoxyribonucleic acid diagnosis of susceptibility to retinoblastoma in relatives of hereditary patients, even if mutations have not been identified.