CLINICAL AND EPIDEMIOLOGICAL CHARACTERISTICS OF PATIENTS DIAGNOSED WITH COVID-19 IN A TERTIARY CARE CENTER IN MEXICO CITY: A PROSPECTIVE COHORT STUDY.

BACKGROUND: Regional information regarding the characteristics of patients with coronavirus disease (COVID)-19 is needed for a better understanding of the pandemic. OBJECTIVE: The objective of the study to describe the clinical features of COVID-19 patients diagnosed in a tertiary-care center in Mexico City and to assess differences according to the treatment setting (ambulatory vs. hospital) and to the need of intensive care (IC). METHODS: We conducted a prospective cohort, including consecutive patients with COVID-19 from February 26, 2020 to April 11, 2020. RESULTS: We identified 309 patients (140 inpatients and 169 outpatients). The median age was 43 years (interquartile range, 33-54), 59.2% men, and 18.6% healthcare workers (12.3% from our center). The median body mass index (BMI) was 29.00 kg/m2 and 39.6% had obesity. Compared to outpatients, inpatients were older, had comorbidities, cough, and dyspnea more frequently. Twenty-nine (20.7%) inpatients required treatment in the IC unit (ICU). History of diabetes (type 1 or 2) and abdominal pain were more common in ICU patients compared to non-ICU patients. ICU patients had higher BMIs, higher respiratory rates, and lower room-air capillary oxygen saturations. ICU patients showed a more severe inflammatory response as assessed by white blood cell count, neutrophil and platelet count, C-reactive protein, ferritin, procalcitonin, and albumin levels. By the end of the study period, 65 inpatients had been discharged because of improvement, 70 continued hospitalized, and five had died. CONCLUSIONS: Patients with comorbidities, either middle-age obese or elderly complaining of fever, cough, or dyspnea, were more likely to be admitted. At admission, patients with diabetes, high BMI, and clinical or laboratory findings consistent with a severe inflammatory state were more likely to require IC.

Integrating the Internship into Ophthalmology Residency Programs: Association of University Professors of Ophthalmology American Academy of Ophthalmology White Paper.

Future ophthalmologists will need to have broad skills to thrive in complex health care organizations. However, training for ophthalmologists does not take advantage of all of the postgraduate years (PGYs). Although the traditional residency years seem to have little excess capacity, enhancing the internship year does offer an opportunity to expand the time for ophthalmology training in the same 4 PGYs. Integrating the internship year into residency would allow control of all of the PGYs, allowing our profession to optimize training for ophthalmology. In this white paper, we propose that we could capture an additional 6 months of training time by integrating basic ophthalmology training into the intern year. This would allow 6 additional months to expand training in areas such as quality improvement or time for "mini-fellowships" to allow graduates to develop a deeper set of skills.

Attitudes toward retirement of ophthalmology department chairs.

PURPOSE: To identify common perceptions and ideas about preparation and planning for retirement of chairs of academic departments of ophthalmology, determining areas of particular stress and proposing ways to better prepare for retirement. DESIGN: Cross-sectional study. PARTICIPANTS: One-hundred sixteen chairs of academic departments of ophthalmology in the United States. METHODS: A confidential online survey emailed to ophthalmology chairs. MAIN OUTCOME MEASURES: Surveys assessed demographics; current work schedule; perceptions, preparation, and planning for retirement; and retirement training for faculty and residents. RESULTS: Ninety-six department chairs responded to the survey (82% response rate). Most chairs anticipate retiring around age 70. Significantly, only 9% are looking forward to retirement. Reasons for delaying retirement include keeping active (37%), income/insurance/benefits (20%), and maintaining lifestyle (17%). The most common concern is financing retirement (46%). Forty percent anticipate their reason for retirement will be because of age or health, whereas 20% anticipate fatigue or burnout. Nearly half of the respondents have no specific plan upon retirement. Most respondents anticipate pursuing other interests (43%); 32% intend to spend time with family, vacationing, and travelling. Younger respondents are more concerned with the financial aspects of retirement while more senior respondents appear to delay retirement to keep active or because they enjoy their work. CONCLUSIONS: Retirement is a source of stress for many ophthalmology department chairs and many indicate financial preparation is their major concern. Despite this, the major reason for putting off retirement is a desire to keep active. Developing a retirement plan eases stress and engenders a feeling of confidence about the future.

Effect of non-alcoholic beer, diet and exercise on endothelial function, nutrition and quality of life in patients with cirrhosis.

BACKGROUND: The implementation of nutritional strategies targeting several variables at once could benefit patients with cirrhosis. Non-alcoholic beer has different compounds that exert antioxidant, anti-inflammatory and nutritional properties. AIM: To evaluate the effect of diet + exercise and non-alcoholic beer on nutritional status, endothelial function and quality of life in patients with cirrhosis. METHODS: In this randomized open clinical trial, patients with cirrhosis were randomized into two groups: The intervention (non-alcoholic beer + diet + exercise) and control (water + diet + exercise) group. Treatment consisted of 330 mL non-alcoholic beer/day or the same amount of water, plus an individualized dietary plan and an exercise program with a pedometer-based bracelet to reach at least 5000 steps/d and > 2500 above the baseline during 8 wk. Endothelial function (flow-mediated dilation, plethysmography), biochemical and nutritional variables and quality of life (CLDQ) were evaluated. RESULTS: Forty-three patients were included in the study, 21 in the control group and 22 in the intervention group. The mean age was 53.5 ± 7.8 years, 60% were women, the median MELD score was 8 (7-10) and most patients were Child-Pugh A (88%). Adherence to the interventions was > 90% in both groups, there were no adverse events and all biochemical parameters remained stable in both groups. Endothelial function improved in both groups. All measured nutritional parameters improved in the intervention group, compared to only 2 in the control group and quality of life improved in both groups; however, more domains improved in the intervention group. CONCLUSION: The intervention consisting of non-alcoholic beer, diet and exercise seems to be safe and well tolerated in patients with cirrhosis, and shows improvement in nutritional status, endothelial function, and quality of life. These results need to be further confirmed.

Twenty-five years of leadership: a look at trends in tenure and appointments of chairs of ophthalmology.

OBJECTIVE: To assess trends in tenure for chairs of academic departments of ophthalmology and to assess characteristics that may be correlated with longevity. DESIGN: Cross-sectional study. PARTICIPANTS: Current chairs from 136 institutions were surveyed. METHODS: Questionnaires mailed to ophthalmology chairs. MAIN OUTCOME MEASURES: Questionnaires assessed demographics along with duration of tenure for current and previous chairs. RESULTS: From 1983 through 2007, 415 individuals (404 men and 11 women) held the position of chair at the 127 responding institutions. The mean duration of tenure for chairs whose tenure included 1980 was 20.3 years, and the mean duration decreased to 14.7 years for chairs whose tenure included 2000. Mean annual turnover changed from 4.8% during the first 5 years of the study to 6.7% during the last 5 years of the study. Departments had an average of 3.3 chairs during this period, with 25 departments having 5 or more new chairs. The number of female chairs increased from 4 in 1983 to 6 in 2007. Length of tenure was not found to correlate with a department's national ranking. CONCLUSIONS: The average turnover rate for chairs of departments of ophthalmology has shown a slight upward trend over the last 25 years with a corresponding decrease in mean tenure length. Although this trend is not particularly alarming compared with those of other disciplines, academic leaders must be aware of this trend to estimate future leadership needs and to take steps to ensure tenure length does not decrease in such a way that it hinders the field.

Age and racial variation in central corneal thickness of preschool and school-aged children.

PURPOSE: The purpose of this study was to determine variations in central corneal thickness (CCT) of preschool and school-aged African American and white children. Secondary aims were to assess possible correlations between CCT measurements and gender, axial length, intraocular pressure (IOP), family history of glaucoma, or history of prematurity. METHODS: Contact ultrasound was used to measure CCT and axial length in 76 white and 60 African American children between the ages of 7 months and 18 years. A questionnaire was completed by the parents or guardians, including medical and family history. Statistically significant associations and differences were assessed using the independent t test, analysis of variance, and linear regression. All associations were defined as significant when the alpha value was less than 0.05 (two-tailed). RESULTS: Mean CCT was thinner in African American children (535 +/- 35 microm) compared to white children (559 +/- 38 microm) (P < .001). The corneal thickness in children ages 10 to 18 years was significantly higher than in all other age groups in both African American (P = .03) and white (P < .005) children. No association was found between CCT and gender, axial length, IOP, or family history of glaucoma. Premature children had thinner CCT (536 +/- 40 pm) than full-term children (552 +/- 38 microm) (P = .009). CONCLUSIONS: African American children have a thinner CCT compared to white children at all ages. Children of both racial groups have an increasing value of CCT with increasing age after approximately age 10 years. Children born prematurely have a thinner CCT than full-term children.

Burnout in chairs of academic departments of ophthalmology.

PURPOSE: To evaluate the incidence of burnout in chairs of academic departments of ophthalmology, identify stressors, and propose methods for reducing and preventing burnout in our academic leaders. DESIGN: Cross-sectional study. PARTICIPANTS: One-hundred thirty-one chairs of academic departments of ophthalmology in the United States and Canada. METHODS: Confidential surveys mailed to ophthalmology chairs. MAIN OUTCOME MEASURES: Questionnaires assessed demographics, potential stressors, satisfaction with personal life, self-efficacy, burnout as measured by the Maslach Burnout Inventory-Human Services Survey (MBI-HSS), and quality of life. RESULTS: Questionnaires were returned from 101 chairs, a response rate of 77%. Each chair had served an average of 9.4 years. They worked an average of 62 hours each week, spending 41% on patient care, 36% on administrative duties, 13% on teaching, and 9% on research. There was no difference in hours worked each week in chairs who had served >10 years from those who had been chair <5 years. The most frequently identified stressors were faculty retention, Residency Review Committee/Accreditation Council for Graduate Medical Education issues, department or hospital budgets, and compliance issues. Seventy percent of chairs reported they are currently satisfied with their positions compared with 79% who reported feeling that way 5 years ago. Nine chairs (9%) were considered to have burnout based on their MBI-HSS surveys, and 9 (9%) chair's scores showed no characteristics of burnout. Fifty-six percent had scores consistent with low personal achievement, the highest risk factor for burnout. Overall, the MBI-HSS revealed moderate subscale scores for emotional exhaustion, low for depersonalization, and low for personal accomplishment. CONCLUSIONS: The overall prevalence of burnout in chairs of academic departments of ophthalmology is similar to burnout rates seen in chairs of other academic departments. The MBI-HSS scores for ophthalmology chairs showed high levels of emotional exhaustion, moderate levels of depersonalization, and moderate levels of personal accomplishment. Because the cost of burnout can be high, both in terms of a chair's psychological well-being and the actual cost associated with replacing a chair, it is important that strategies are put in place to reduce burnout in our academic leaders.

Factors associated with recurrence of amblyopia on cessation of patching.

PURPOSE: In a prospective observational study, we previously reported that weaning (tapering or gradually reducing) treatment in children treated with 6 to 8 hours of daily patching for amblyopia resulted in a 4-fold reduction in odds of recurrence. We now report the association of additional factors with recurrence or regression of amblyopia in this same cohort. DESIGN: Prospective, nonrandomized, observational study. PARTICIPANTS: Sixty-nine children aged <8 years with successfully treated anisometropic or strabismic amblyopia (improved > or =3 logarithm of the minimum angle of resolution [logMAR] lines). METHODS: Patients were enrolled at the time they stopped patching for amblyopia. Patients were classified according to whether patching was stopped abruptly or weaned before cessation. They were followed off treatment for 52 weeks to assess recurrence of amblyopia. MAIN OUTCOME MEASURE: Recurrence of amblyopia defined as a > or =2-logMAR level reduction of visual acuity from enrollment (cessation of patching) confirmed by a second examination. Recurrence was also considered to have occurred if treatment was restarted with a > or =2-logMAR level reduction of visual acuity, even if it was not confirmed by a second examination. RESULTS: The risk of recurrence was higher with better visual acuity at the time of cessation of treatment (adjusted risk ratio [RR], 0.68 per line of worse visual acuity; 95% confidence interval [CI], 0.51-0.90), a greater number of lines improved during the previous treatment (adjusted RR, 1.5 per line increase; 95% CI, 1.1-2.0), and a history of recurrence (adjusted RR, 2.7; 95% CI, 1.5-4.9). Orthotropia or excellent stereoacuity at the time of patching cessation did not appear to have a protective effect on the risk of recurrence. CONCLUSIONS: The higher risk of recurrence in the most successfully treated children with amblyopia and absence of protection from orthotropia and excellent random dot stereoacuity suggests that careful and prolonged follow-up is needed for all children who have been previously treated for amblyopia.

Comparison of two different surgical techniques for the treatment of strabismus in dysthyroid ophthalmopathy.

BACKGROUND: Surgical management of strabismus caused by dysthyroid ophthalmopathy has a history of variable success outcomes ranging from 43% to 82%. Previous studies showed that correcting the restricted duction seen in thyroid eye disease, rather than the deviation as is done in other types of strabismus surgery, resulted in markedly improved success rates. Other investigators have recommended a change in the approach to the surgical management of dysthyroid ophthalmopathy. METHODS: Retrospective comparison of sequential case series. RESULTS: The data of 86 patients were retrospectively reviewed, including 52 in the deviation correction group and 34 in the duction correction group, with 74 deviation correction operations and 47 duction correction operations. A successful outcome, defined as postoperative deviation less than or equal to 5(Delta), was seen in 72% of deviation corrections operations and 66% of duction correction operations (p = 0.55). CONCLUSIONS: In our study, no difference in outcome between surgical corrections of restricted duction versus deviation was demonstrated.

Cataract associated with type-1 diabetes mellitus in the pediatric population.

PURPOSE: To report 14 cases (28 eyes) of cataract associated with type-1 diabetes mellitus in young children and adolescents. METHODS: Retrospective review of the medical records of 14 patients from seven institutions. All patients under the age of 18 years who met the inclusion criteria of type-1 diabetes mellitus and cataract were included. RESULTS: Mean age at the time of diabetes diagnosis was 9.8 years (range, 0.5-14 years), and mean age at cataract diagnosis was 11.7 years (range, 5-16 years). Two patients presented with cataracts one month before the diagnosis of diabetes; seven after the diagnosis of diabetes; and in five patients the cataract was found at the time the diabetes was diagnosed by the pediatrician. Nineteen out of 23 operated eyes had a best corrected post operative visual acuity of 20/40 or better. Two patients (4 eyes) developed diabetic retinopathy postoperatively. CONCLUSIONS: Although cataract formation in type-1 diabetes is rare, it is treatable and potentially sight-saving in young children and adolescents.

Results of combined resection-recession on a single rectus muscle for incomitant deviations-an alternative to the posterior fixation suture.

PURPOSE: To compare outcomes of combined resection and recession on previously unoperated single horizontal or vertical rectus muscles in consecutive adult patients with acquired incomitant deviations minimal in primary gaze and maximal in an eccentric gaze position. METHODS: The surgical goal was to decrease the incomitance by 50%, expand the field of binocular single vision, and relieve diplopia. Recessions for the maximal deviations were combined with smaller resections using hang-back, nonadjustable sutures. Pre- and postoperative incomitance was compared using the paired t test. RESULTS: A total of 16 adults were studied (mean age at surgery, 49.3 ± 17.5 years), 12 with incomitant vertical deviations and 4 with incomitant horizontal deviations. Eight patients had preoperative deviations of <2Δ in primary gaze (mean, 9.2Δ ± 10.5Δ; range, 1Δ-35Δ). The mean maximum eccentric gaze deviation was 21.4Δ ± 9.9Δ (range, 10Δ-48Δ). Postoperatively, 12 patients (75%) had a decrease in incomitance of >50%, and all had expansion of the field of binocular single vision. Improvement in postoperative incomitance was highly statistically significant in the vertical incomitant group (P < 0.0001) but not statistically significant in the horizontal group (P = 0.39). The technique corrected downgaze deviations in 4 patients with canine tooth syndrome (93% ± 3.3, P < 0.0001) without worsening the hypotropia in upgaze. CONCLUSIONS: Combined resection-recession single muscle surgery significantly reduces incomitance with minimal effect on primary gaze. It is most effective for treating vertical deviations worse on downgaze with primary gaze deviations of <2Δ and for canine tooth syndrome; the technique was less successful in reducing horizontal incomitance and in cases involving gaze palsies and nystagmus.

Effectiveness of Bilateral Lateral Rectus Resection for Residual Esotropia in Dysthyroid Ophthalmopathy.

PURPOSE: To report one surgeon's experiences with bilateral lateral rectus resections in dysthyroid ophthalmopathy patients with residual esotropia after initial bilateral medial rectus recession. DESIGN: Retrospective interventional case series evaluating outcomes. METHODS: Medical records for patients with dysthyroid ophthalmopathy who underwent bilateral lateral rectus resections for persistent esotropia by a single surgeon from June 2012 to June 2015 were retrospectively reviewed. All patients had residual esodeviations following initial bilateral medial rectus recession. The goal of surgery was to obtain fusion in primary gaze and the reading position without prism, with a postoperative deviation equal to or less than 8Δ at distance and a phoria at near without diplopia. RESULTS: Seven of the 9 patients were successful in achieving this goal. Preoperative esotropia before resection ranged from 12Δ to 30Δ (23.1Δ ± 10.3Δ) at distance and -2Δ to 40Δ (14.9Δ ± 12.3Δ) at near. No exodeviation was created at near by the resections, but 1 patient had an asymptomatic exophoria both pre- and postoperatively. CONCLUSION: Patients with large horizontal misalignment may have residual esodeviations that are too large for correction with recession alone. Given our findings, we believe resection may be an effective tool in resolving esotropia in certain patients with restrictive strabismus.

Caracterización de la tuberculosis multidrogorresistente y resistente a rifampicina en Colombia / Characterization of rifampin-resistant/multidrug-resistant tuberculosis in Colombia

RESUMEN Objetivo Caracterizar la población afectada por tuberculosis multidrogorresistente y resistente a rifampicina (TB-MDR/RR) en Colombia. Métodos Estudio transversal a partir de la información nominal de los pacientes con TB-MDR/RR tratados y reportados en Colombia desde 2009 hasta 2020, usando la totalidad de las fuentes de información oficiales. Se compararon, además, las tasas de TB-MDR/RR de diferentes grupos de riesgo con la de la población general y se evaluaron variables asociadas a la TB-MDR/RR extrapulmonar y a resistencias medicamentosas. Resultados La TB-MDR/RR ha aumentado progresivamente durante la última década y se ha concentrado en hombres (64% vs. 36%, p<0,001), edades medias (mediana: 39,5 años; RIC: 27) y zonas de mayor densidad poblacional (59% de los casos en Antioquia, Valle del Cauca y Santiago de Cali). Además, al compararlas con las poblaciones de referencia que aplicaran, se evidenciaron tasas 2, 10 y 200 veces mayores en población indígena (9,45/1 000 000 vs. 4,31/1 000 000; p=0,02), prisioneros (169/1 000 000 vs. 16,9/1 000 000; p<0,001) y habitantes de calle (21/100000 vs. 0,1/100 000; p<0,001), respectivamente. Conclusiones El aumento en los casos de TB-MDR/RR y sus grupos de riesgo deben tenerse en cuenta para la planeación de políticas, distribución de recursos y atención clínica.

ABSTRACT Objective To describe the population affected by rifampin-resistant/multidrug-resistant tuberculosis (RR/MDR-TB) in Colombia. Methods Cross-sectional study on all the patients treated for RR/MDR-TB in Colombia between 2009 and 2020, using all the official sources of information. In addition, a comparison was made between the rates of RR/MDR-TB in some higher-risk groups and average population. Finally, the variables associated to pulmonary versus extrapulmonary RR/MDR-TB and those associated to resistance to other drugs were evaluated. Results RR/MDR-TB cases have progressively increased during the last decade. These cases were concentrated in men (64% vs. 36%, p<0.001), middle aged adults (median: 39.5 years old; IQR: 27), and in geographic regions with higher population density (59% of cases in Antioquia, Valle del Cauca and Santiago de Cali). Also, the rate of RR/MDR-TB was 2, 10 and 200 times higher in indigenous (9.45/1 000 000 vs. 4.31/1 000 000; p=0.02), prisoners (169/1 000 000 vs. 16.9/1 000 000; p<0.001), and homeless population (21/100 000 vs. 0.1/100 000; p<0.001), respectively. Conclusions The increase in RR/MDR-TB cases and their concentration in higher-risk groups must be kept in mind to make better policies, a more efficient distribution of resources, and better patient care.

Randomized trial of treatment of amblyopia in children aged 7 to 17 years.

OBJECTIVE: To evaluate the effectiveness of treatment of amblyopia in children aged 7 to 17 years. METHODS: At 49 clinical sites, 507 patients with amblyopic eye visual acuity ranging from 20/40 to 20/400 were provided with optimal optical correction and then randomized to a treatment group (2-6 hours per day of prescribed patching combined with near visual activities for all patients plus atropine sulfate for children aged 7 to 12 years) or an optical correction group (optical correction alone). Patients whose amblyopic eye acuity improved 10 or more letters (> or =2 lines) by 24 weeks were considered responders. RESULTS: In the 7- to 12-year-olds (n = 404), 53% of the treatment group were responders compared with 25% of the optical correction group (P<.001). In the 13- to 17-year-olds (n = 103), the responder rates were 25% and 23%, respectively, overall (adjusted P = .22) but 47% and 20%, respectively, among patients not previously treated with patching and/or atropine for amblyopia (adjusted P = .03). Most patients, including responders, were left with a residual visual acuity deficit. CONCLUSIONS: Amblyopia improves with optical correction alone in about one fourth of patients aged 7 to 17 years, although most patients who are initially treated with optical correction alone will require additional treatment for amblyopia. For patients aged 7 to 12 years, prescribing 2 to 6 hours per day of patching with near visual activities and atropine can improve visual acuity even if the amblyopia has been previously treated. For patients 13 to 17 years, prescribing patching 2 to 6 hours per day with near visual activities may improve visual acuity when amblyopia has not been previously treated but appears to be of little benefit if amblyopia was previously treated with patching. We do not yet know whether visual acuity improvement will be sustained once treatment is discontinued; therefore, conclusions regarding the long-term benefit of treatment and the development of treatment recommendations for amblyopia in children 7 years and older await the results of a follow-up study we are conducting on the patients who responded to treatment.

Success of simple probing and irrigation in patients with nasolacrimal duct obstruction and otitis media.

PURPOSE: To examine whether, as has been reported in the literature, a history of otitis media (OM) affects the success of probing and irrigation (P&I) for nasolacrimal duct obstruction (NLDO). METHODS: All patients who underwent P&I at the Saint Louis University Eye Institute between 2001 and 2002 were prospectively studied. A preoperative questionnaire assessed the laterality of NLDO and history and laterality of OM. Intraoperatively, site of NLDO and recovery of fluorescein were recorded. The success of the probing was determined by follow-up interview 6 months postoperatively. RESULTS: Overall success of initial P&I was 86.2%. Patients with OM did not have a statistically significant decrease in success of P&I ( P = 1.00, RR 0.920, 95% CI 0.298-2.736 by Yates-corrected chi-square). The failure rate of initial P&I was not statistically different regardless of fluorescein recovery. NLDO occurred most frequently at the valve of Hasner (45.8%). CONCLUSIONS: OM was not a risk factor for initial P&I failure. Omission of fluorescein irrigation to assess patency may save time and cost.