Rocahepevirus ratti as an Emerging Cause of Acute Hepatitis Worldwide.

The hepatitis E virus (HEV) is a widespread human infection that causes mainly acute infection and can evolve to a chronic manifestation in immunocompromised individuals. In addition to the common strains of hepatitis E virus (HEV-A), known as Paslahepevirus balayani, pathogenic to humans, a genetically highly divergent rat origin hepevirus (RHEV) can cause hepatitis possessing a potential risk of cross-species infection and zoonotic transmission. Rocahepevirus ratti, formerly known as Orthohepevirus C, is a single-stranded RNA virus, recently reassigned to Rocahepevirus genus in the Hepeviridae family, including genotypes C1 and C2. RHEV primarily infects rats but has been identified as a rodent zoonotic virus capable of infecting humans through the consumption of contaminated food or water, causing both acute and chronic hepatitis cases in both animals and humans. This review compiles data concluding that 60% (295/489) of RHEV infections are found in Asia, being the continent with the highest zoonotic and transmission potential. Asia not only has the most animal cases but also 16 out of 21 human infections worldwide. Europe follows with 26% (128/489) of RHEV infections in animals, resulting in four human cases out of twenty-one globally. Phylogenetic analysis and genomic sequencing will be employed to gather global data, determine epidemiology, and assess geographical distribution. This information will enhance diagnostic accuracy, pathogenesis understanding, and help prevent cross-species transmission, particularly to humans.

Distance Surgical Mentorship for Ophthalmologists in Northern Peru.

This article was migrated. The article was marked as recommended. Purpose: To evaluate the quality of live distance surgical mentorship as an alternative way to provide continuing professional development (CPD) to practicing ophthalmologists. An activity which could be particularly beneficial to surgeons in remote locations where CPD is difficult to access. Methods: Orbis paired ophthalmologists from the Regional Institute of Ophthalmology (IRO) in Trujillo, Peru and a senior ophthalmologist from Vanderbilt Eye Institute in Tennessee, USA (LW). One week in advance, the Peruvian surgeon sent the mentor patient information confidentially via Cybersight.org, Orbis' telemedicine platform. The mentor reviewed the preoperative information to determine if the case was appropriate for remote guidance and formulated questions to help guide the educational experience. The mentor and mentee also consulted on specific learning objectives. The mentor observed live phacoemulsification surgery over the Internet using audio-visual equipment and Zoom desktop video conferencing software, allowing her to see through the operating microscope in real-time and have constant voice contact with the local surgeon. Post-mentorship a survey was administered to gauge acceptability of the CPD method, as well as their self-assessment on its impact on their skill development. Results: Latency experienced was well within the suggested margin of acceptability and the video quality was broadcast-grade, allowing the mentor to clearly see the anatomy and instrument manipulation. Seven surgeons over four sessions performed twelve phacoemulsification surgeries in Peru, 91.67% of those 12 patients achieved postoperative best corrected visual acuity ≥6/18. Four surgeons completed the survey and 100% agreed or strongly agreed that their objectives had been met and that the CPD had increased their confidence and their surgical skills. The step in the procedure most commonly reported for improvement was nuclear cracking (75% of respondents), followed by hydrodissection, quadrant removal and wound closure (50% each). Conclusions: Distance surgical mentorship in phacoemulsification is an acceptable form of CPD for consultant ophthalmologists. We describe a program with positive user feedback and experiences of improved confidence and microsurgical skill among participants.

Implementation of a diabetic retinopathy referral network, Peru.

OBJECTIVE: To describe the implementation of a diabetic retinopathy referral network incorporating all levels of health care in La Libertad region, Peru. METHOD: The nongovernmental organization Orbis International and the Regional Institute of Ophthalmology established a network of primary, secondary and tertiary health-care facilities for diabetic retinopathy screening and treatment. The programme included the provision of three non-mydriatic retinal cameras for patient examination, the development of a flowchart to guide patient referrals, training of health personnel, investment in laser technology for treatment and the delivery of public awareness activities for blindness prevention and the need for timely screening. FINDINGS: From 2014-2017, 11 849 patients with diabetes were screened within the diabetic retinopathy referral network. In primary-care centres, 6012 patients with diabetes mellitus were identified and 5632 patients were referred for diabetic retinopathy screening. A further 4036 patients directly attended two secondary-level hospitals and 2181 attended the tertiary-level hospital for screening. This represented a 138.1% increase in diabetic retinopathy screenings from a baseline of 4977 patients screened at the regional institute of ophthalmology over 2010-2013. A total of 2922 patients (24.7%) were found to have diabetic retinopathy and 923 (31.6%) were treated: 508 with laser photocoagulation, 345 with intravitreal bevacizumab and 70 with vitreoretinal surgery. CONCLUSION: Effective and timely treatment for diabetic retinopathy is possible when patient education, screening and care are fully integrated into the general health-care system across primary-, secondary- and tertiary-level facilities. This requires the integration of professionals at all levels and all relevant specialties.