Prevalence of Sarcoptes scabiei infestation and its associated factors among primary school children: A school-based cross-sectional survey in the Rufiji district, Tanzania.

Objectives: This study aimed to investigate the prevalence of Sarcoptes scabiei infestation and its associated factors among primary school children (PSC) in the Rufiji district. Methods: A quantitative school-based cross-sectional study was conducted among 447 PSC in the Rufiji district. The prevalence of scabies among PSC was determined by clinical examination and by microscopic examination of skin samples for the presence of S. scabiei. A structured questionnaire was used to gather data on factors associated with S. scabiei infestation. Descriptive analysis, Fisher's exact, chi-square tests, and logistic regression analysis were used to analyze the data. Results: The prevalence of scabies was 2.0%. Of the assessed factors, only physical contact with a person having itchy skin lesions (Adjusted Odds Ratio [AOR]=4.04, 95%CI 4.39-12.50) and infrequency of changing clothes before laundry (AOR=2.99, 95%CI 1.35-4.94) were significantly associated with scabies. The majority of participants demonstrated low levels of knowledge, with half exhibiting poor attitudes and inappropriate healthcare-seeking behaviors. Conclusions: There was an ongoing transmission of scabies among PSC in the Rufiji district, with the factors associated with the transmission being physical contact with a person who had an itchy skin lesion and the infrequency of changing clothes before laundry. Therefore, there is a need for regular clinical screening and treatment of positive cases with preventive measures on contact and provision of health education.

Factors influencing maternal death surveillance and review implementation in Dodoma City, Tanzania. A qualitative case study.

Background: With 295 000 maternal deaths in 2017, 94% in low- and middle-income countries, maternal death is a matter of global public health concern. To address it, Maternal Death Surveillance and Response (MDSR) strategy was introduced in 2013 by the World Health Organization. With a reported maternal mortality ratio of 556:100000 per live births, Tanzania adopted the strategy in 2015. Studies are needed to understand factors influencing the implementation of MDSR in this specific setting. Aims and Objectives: The study aimed to assess the processes influencing MDSR implementation in Dodoma city council. Methods: A qualitative case study was conceptualized according to the Consolidated Framework for Implementation Research, focusing on implementation process domain. Members of MDSR committees were enrolled by purposeful sampling in the five health centres in Dodoma where the strategy was fully implemented and functional. In-depth interviews were conducted with key informants concerning the implementation processes influencing MDSR. Saturation was reached with the 15th respondent. Qualitative inductive content analysis was used to analyse data. Results: The inclusiveness in participatory planning process, stakeholders' readiness and accountability and collective learning were acknowledged as factors positively influencing the implementation of MDSR strategy by respondents. The interaction and alignment of influential factors were essential for successful implementation. Conclusions: MDSR implementation is positively influenced by factors that interact and converge in the building of a learning health system, to increase knowledge through practice and improve practice through knowledge. Further studies are needed to analyse the influence of additional factors at different levels of implementation to fully understand and empower the MDSR implementation network, and to better target the goal of closing the knowledge to practice loop.

The Effect of Varied Microperimetric Biofeedback Training in Central Vision Loss: A Randomized Trial.

SIGNIFICANCE: This investigation reports for the first time the effects of different microperimetric biofeedback strategies in visually impaired subjects with central field loss. PURPOSE: This study aimed to evaluate the effects of two MP-3 microperimeter biofeedback strategies on the visual performance of subjects with central vision loss. Moreover, changes between the groups were compared to provide indications of practice with biofeedback stimulation in subjects with central vision loss. METHODS: Using simple randomization, 19 participants were trained according to two different biofeedback stimulation approaches using the MP-3 microperimeter. Patients were assigned to two different groups: subjects trained for 2 days a week (group A) and 3 days a week (group B). The patients in each group were randomized to perform a total of 10 or 15 sessions. RESULTS: Fixation stability increased from 4.5 ± 2.8 to 2.3 ± 2.2° 2 and from 8.2 ± 6.9 to 1.4 ± 1° 2 after 2 and 3 weekly biofeedback training sessions, respectively ( P < .05). Biofeedback training induced a significant improvement of 40.7 and 29.4% in reading speed for groups A and B, respectively ( P < .05). A comparison of two weekly biofeedback training sessions with three weekly biofeedback sessions demonstrated greater fixation stability in group B ( P < .05). CONCLUSIONS: This study concludes that a biofeedback intervention is effective in enhancing oculomotor control in patients with central vision loss. In our study, a more intensive biofeedback strategy seemed to produce significantly better results in terms of functional vision parameters.

Prevalence and factors associated with ongoing transmission of Schistosoma haematobium after 12 rounds of Praziquantel Mass Drug Administration among school age children in Southern Tanzania.

Background: World Health Organization (WHO) recommends periodic praziquantel Mass Drug Administration (MDA) to vulnerable populations, especially school-aged children, to reduce the risk of transmission. In the S. haematobium endemic Lindi region, on the southeastern coast of Tanzania, praziquantel has been distributed for more than a decade (12 rounds) in schools. However, there is a paucity of data on the current burden and factors perpetuating ongoing urogenital schistosomiasis among SAC. The study investigated the prevalence and factors associated with the ongoing transmission of S. haematobium among school-age children (SAC) after 12 rounds of praziquantel in Nachingwea, Southern Tanzania. Material and methods: A quantitative cross-sectional study was conducted between May and June 2022 among 483 SAC in the Nachingwea district. Macrohematuria, microhaematuria, and S. haematobium eggs were assessed in the collected urine sample for each participant, using macroscopic observation, urine dipstick, and urine filtration techniques, respectively. Infection intensity was quantified for positive S. haematobium urine samples. Knowledge and attitudes towards schistosomiasis were assessed among participants through an interview-administered questionnaire, and water contact practices were registered through an observation checklist. Data were summarized using descriptive statistics, the Chi-square test, and logistic regression. Results: The prevalence of S. haematobium infection was 10.6%, with 0.6% (3/51) prevalence of heavy infection. The factors associated with S. haematobium persistence transmission were a habit of visiting the water bodies (AOR = 1.62, 95% CI: 0.40-1.96), swimming in the visited water bodies (AOR = 4.58, 95% CI: 1.72-12.19), using water from the river source (AOR = 3.79, 95% CI: 1.51-9.51) and attending Mkumba Primary School (17.4%; AOR = 6.12, 95% CI: 1.64-22.85). Conclusions: Findings suggest ongoing transmission of urogenital schistosomiasis in the Nachingwea District despite 12 rounds of praziquantel treatment, with a low prevalence of heavy infection (0.6%). Praziquantel distribution should be complemented with health education, especially on the cause and transmission of urogenital schistosomiasis to increase knowledge that will improve a good attitude towards schistosomiasis prevention. An adequate water supply is to be considered to reduce infections due to the visit to water sources for daily use.

Ovarian schistosomiasis: challenges of a neglected ectopic involvement of blood flukes. Case report and review of literature.

Introduction: Female genital schistosomiasis (FGS), infection of Schistosoma spp. trematode in the gynaecological apparatus, is the most neglected sexual and reproductive health condition in sub-Saharan Africa with an estimated of 20-120 million cases. The ectopic entrapment of Schistosome eggs after oviposition can occur in 0.5% of cases in fallopian tubes and ovaries. The case: We report a case of 38-years-old woman assessed for a 10 year history of infertility. On ultrasound, multiple cystic formations were observed in the ovary. Histology after oophorectomy to exclude malignancy showed granulomatous formations surrounding Schistosoma spp. eggs in proximity of corpus luteus and haemorragicum. Discussion: Ectopic Schistosome oviposition, seen in the ovary and fallopian tubes as in our case, can be a potential cause of reproductive organ damage and complications such as infertility, ectopic pregnancy, miscarriage, premature birth, low birth weight, and even maternal death. Conclusions: More studies are needed on ovarian FGS and its impact on women fertility to guide specific interventions targeting vulnerable population of childbearing age, contributing to the NTD WHO 2030 aim of eliminating schistosomiasis as a matter of public health.

Burden and factors associated with ongoing transmission of soil-transmitted helminths infections among the adult population: A community-based cross-sectional survey in Muleba district, Tanzania.

BACKGROUND: In Tanzania, school-based Mass Drug Administration (MDA) campaigns have been the main strategy for the prevention and control of Soil Transmitted Helminths (STH) infection. Adults are not part of the program and could remain as the reservoir of infection, favoring continuity in transmission. Water, Sanitation, and Hygiene (WaSH) issues and slow progress in community awareness promotion campaigns contribute to the persistence of STH as public health issue among target populations notwithstanding the achievements of the control interventions. OBJECTIVE: This study aimed to determine the current prevalence and the risk factors associated with ongoing transmission of STH infection among adults in Muleba District, Tanzania. METHODOLOGY: A household-based quantitative cross-sectional study was carried out among 552 adults in Muleba district. Through a quantitative interviewer-administered questionnaire, information was registered related to socio-demographic characteristics, level of knowledge on the disease, and WaSH factors. The prevalence of STH and estimation of its intensity were assessed by analyzing stool samples through formol-ether concentration and the Kato-Katz technique. Descriptive statistics was used to summarise data; logistic regression to determine the association between STH infection and socio-demographic and WaSH factors. A p-value < 0.05 was considered statistically significant. RESULTS: A total of 552 adults were included in the study; 50.7% (280/552) were female. The median age was of 30 years, ranging from 18 to 73 years. A prevalence of 9.1% (50/552) for STH infection was reported; the prevalence of Hookworm Spp., Ascaris lumbricoides, and Trichuris trichiura was 7.43%, 0.91%, and 0.72%, respectively. The factors significantly associated with STH infection were farming (aOR = 3.34, 95% CI: 1.45-7.70), the habit of not wearing shoes in general (aOR = 5.11, 95% CI: 1.55-16.87), and during garden activities (aOR = 4.89, 95% CI: 1.47-16.28). CONCLUSIONS AND RECOMMENDATIONS: We observed an aggregated prevalence of STH infections (Ancylostoma duodenale, Trichuris trichiura, and Ascaris lumbricoides) of 9.1% among the adult population, indicating a decreasing prevalence but ongoing transmission. Integrated management is needed to address practices contributing to ongoing transmission.

Burden and factors associated with onchocerciasis transmission among school-aged children after more than 20 years of Community Directed Treatment with Ivermectin in Ulanga district, Tanzania: A school-based cross-sectional study.

Onchocerciasis transmission in the Ulanga District of Morogoro-Tanzania is still ongoing despite more than 20 years of Community Directed Treatment with Ivermectin (CDTI) in the area. Even though surveys conducted over the years in the area have revealed a decrease in the prevalence of onchocerciasis, the prevalence of comorbidities suggested to be associated with this filarial infection, as epilepsy, is rising in endemic regions. This fact suggests continued transmission of Onchocerca volvulus and emphasizes the need for the evaluation of factors associated with it among school aged children. Therefore, this study determined the current burden of onchocerciasis in children aged 6 to 12 years and factors associated with continued transmission despite more than 20 years of CDTI in Ulanga District, Morogoro Region-Tanzania. A school-based cross-sectional study was conducted among 270 children aged 6 to 12 years in Ulanga District. Participants were tested using the OV-16 IgG4 Rapid Test. An interview-administered questionnaire was used to assess disease-associated symptoms, knowledge of onchocerciasis, and factors associated with continued transmission of the disease among participants. Descriptive statistics, chi-square test, and logistic regression were performed during data analysis. The prevalence of onchocerciasis was 19.6% (53/270), with boys being more infected; prevalence increased with increasing age groups and was higher in rural areas. Sex (AOR = 2.2, 95% CI: 1.13-4.28), age group of 11-12 years (AOR = 31.45, 95% CI: 2.73-362.27), and not taking ivermectin (AOR = 3.17, 95% CI: 1.53-6.58) were the only significant factors identified to be associated with the transmission of onchocerciasis in this study. The high prevalence of onchocerciasis among school age children in Ulanga district suggests continued transmission in the area. Therefore, a need to integrate CDTI with health education on the importance of ivermectin uptake.

Tungiasis infection among primary school children in Northeastern Tanzania: prevalence, intensity, clinical aspects and associated factors.

Objective: To investigate the prevalence, intensity, clinical aspects and factors associated with tungiasis infection among primary school children in Northeastern Tanzania. Methods: A quantitative school-based cross-sectional study was conducted among 401 primary school children. Participants were assessed through clinical examination to look for embedded Tunga penetrans in their hands, feet, arms and legs. A structured questionnaire was used to enquire about factors associated with tungiasis infection. The data were analysed using descriptive statistics, Chi-squared test and logistic regression, with p<0.05 taken to indicate significance. Results: The overall prevalence of tungiasis infection was 21.2%. Of the 85 tungiasis-infested children, 54 [63.5%, 95% confidence interval (CI) 53.1-74.1] had mild infection, 25 (29.4%, 95% CI 19.0-39.6) had moderate infection, and six (7.1%, 95% CI 1.2-12.9) had heavy infection. A moderate level of knowledge was significantly associated with high odds of tungiasis infection [adjusted odds ratio (AOR) 3.16, 95% CI 1.50-6.67], while not keeping a dog/cat at home was a protective factor (AOR 0.47, 95% CI 0.25-0.89). Conclusions: Moderate prevalence of tungiasis infection was observed among primary school children favoured by factors related to the host, parasitic agent and environment. There is a need for a health education programme in schools encouraging use of appropriate footwear (closed shoes), use of locally accessible repellents (coconut oil), fumigation of households, and washing dogs/cats with insecticides.

Subclinical vascular damage in Schistosoma spp. endemic regions.

Background: Cardiovascular abnormalities have been described in patients with schistosomiasis. Their true prevalence and clinical features in endemic settings are unknown. Patients and methods: The study aimed to assess the prevalence of subclinical cardiovascular damage in a population endemic to schistosomiasis. A cross-sectional study was conducted using colour-ultrasound assessment of abdominal and carotid arteries among adults aged >18 years living in Kome Island, Tanzania. Carotid intimal medial thickness, carotid plaque, mean abdominal aortic diameter, and presence of aneurysms were assessed. Anamnestic data on previous Schistosoma infection was collected; the actual prevalence of Schistosoma mansoni and Schistosoma haematobium was also assessed through stool and urine investigations. Results: A total of 264 participants (166 female, 98 male) were enrolled (mean age of 50±15.5 years). The history of previous schistosomiasis was 27.3%, and actual positivity for Schistosoma mansoni was 5.9%. The Latero-lateral Abdominal Aortic Diameter was significantly increased among participants with a previous history of schistosomiasis (16.7±2.8 mm vs. 17.6±3 mm; p=0.02), with an aOR of 1.15 [CI 1.04-1.28]; p=0.007]. Conclusions: The significant difference in the Latero-lateral Abdominal Aortic Diameter in participants with previous Schistosomiasis history schistosomiasis, suggests the need for further investigations on aortic damage in endemic populations, independently from the positive laboratory investigations.

Intestinal schistosomiasis among secondary school students in Northern Tanzania: prevalence, infection intensity and associated risk factors.

Objective: Our study investigated the prevalence, infection intensity and associated risk factors of intestinal schistosomiasis among secondary school students in Shinyanga Municipal Council, Northern Tanzania. Methods: A quantitative school-based cross-sectional study was conducted from June to August 2022 among 620 secondary students. One stool specimen per participant was collected and screened for Schistosoma mansoni ova by microscopy using the Kato-Katz technique. Ova were counted to estimate infection intensity in all positive stool samples. Participants' socio-demographic characteristics and risk factors for intestinal schistosomiasis were gathered using a structured questionnaire. Data analysis consisted of descriptive statistics, Chi-square test and logistic regression. Results: Overall prevalence of S. mansoni was 1.9%. All infected participants had light infection intensity. Overall prevalence of other intestinal parasites was 2.7%, with Hookworm spp (17.6%) and Entamoeba coli (52.9%) the most observed intestinal helminth and protozoa, respectively. Among assessed factors, being in form II or III, visiting water sources and doing activities in water sources were statistically significantly associated with increased risk of S. mansoni transmission. Conclusions: There is ongoing transmission of intestinal schistosomiasis among secondary students. Hence, the need for extending praziquantel administration in this group, health education provision, and improvement of water supply, sanitation and hygienic practices.

Efficacy and Patients' Satisfaction with the ORCAM MyEye Device Among Visually Impaired People: A Multicenter Study.

To evaluate usability of and satisfaction with OrCam MyEye, a finger-size wearable assistive technology device for visually impaired during real-world tasks. This prospective multicenter study was conducted on visually impaired people recruited from 5 vision rehabilitation centers. Patients performed real-world tasks such as near and distance reading, money handling, colour identification and face recognition in 2 different scenarios: without using any low vision aid and with OrCam. System Usability Scale (SUS), Patient's Global Impression of Change (PGIC), the Quebec User Evaluation of Satisfaction with Assistive Technology (QUEST 2.0) and the Psychosocial Impact of Assistive Devices Scale (PIADS) were administered after the use of the OrCam device. Among the 100 participants, use of OrCam MyEye device improved many daily-living tasks (F = 1.67, P < .05), and in particular reading and face recognition. Multivariate logistic regression showed that age and visual field defect explained 89% of the variation in efficacy of the device. Nearly half (45%) of the participants indicated a positive rating with the SUS. The PGIC rates showed a minimal improvement with a mean score of 4.2 (SD:1.8). The most highlighted parameter with the QUEST 2.0 test was "ease of use" in 58% (48 subjects). The PIADS indicator showed that the device positively impacted on the daily-living tasks of users (r2 = 0.72, P < .05). Regression modelling demonstrated a good relation between the questionnaires scores and demographic, disease and visual factors (P < .05). OrCam MyEye allowed visually impaired people to read, handle money and face recognition independently. This device may offer to these subjects to be independent.

Burden and risk factors for Schistosoma mansoni infection among primary school children: A quantitative school-based cross-sectional survey in Busega district, Northern Tanzania.

BACKGROUND: Intestinal schistosomiasis is one of the most common neglected tropical diseases in Tanzania. Despite massive praziquantel administration, data from Northern Tanzania have reported a prevalence of up to 93.2%. Because the disease is focal, depending on host, environmental and intermediate host factors, there is a need to acquire data in specific settings to better tailor interventions. Therefore, the study assessed the prevalence and factors associated with persistent transmission of intestinal schistosomiasis among school-age children in Busega district, Northern Tanzania. METHODS: A school-based cross-sectional study was conducted among 363 primary school children, randomly selected from school clusters in the Busega district. A single stool sample was collected from each child for S. mansoni ova and infection intensity examination using Kato-Katz. Factors related to intestinal schistosomiasis transmission were acquired through a questionnaire. A malacological survey was carried out to determine the Biomphalaria infectivity rate. Descriptive statistics and logistic regression analysis were conducted to analyse the association between schistosoma infection and factors related to transmission in this setting. RESULTS: The prevalence of S. mansoni infection was 41.3% (95% CI: 36.3-46.5), statistically significantly higher among the younger group aged less than 11 years (46.4% vs 35.3%, p = 0.032). The intensity of infection was heavy in 1.6% of participants, moderate in 9.6%, and light in 30.9%. Studying at Mwamayombo Primary School (AOR = 2.50, 95% CI: 1.12-5.60) was the only factor significantly associated with S. mansoni infestations. The snail intermediate host belonged to Biomphalaria sudanica species, whose infectivity rate was quantified as 0.97%, thus confirming ongoing transmission in the area. CONCLUSIONS: There was a high prevalence of S. mansoni infection among school-age children in the Busega district. The presence of the infected Biomphalaria sudanica in the area documents the persistent transmission of the disease, favored by low knowledge and negative attitudes among school-aged children. Hence, the need for multi-approach intervention for schistosomiasis prevention and elimination.

Blood Flukes and Arterial Damage: A Review of Aneurysm Cases in Patients with Schistosomiasis.

Introduction: Schistosomiasis, caused by trematode worms of the genus Schistosoma, has organ-specific morbidity due to host's inflammatory response to the oviposition of parasite eggs in vessels and organs. Damage to the cardiovascular system, including aneurysms, has been described in patients. Aims and Methods. Aims of the review of case reports and series published in literature were to describe the occurrence of aneurysm in patients with schistosomiasis. Investigation Outcomes. A total of 13 cases (seven males and six females) with a mean age of 41.3 ± 14.9 years were included. Aneurysm occurred in patients with active or previous infection. In more than half of the cases, an intestinal or hepato-splenic involvement was reported, followed by pulmonary schistosomiasis and urinary or testicular involvement. The most frequently involved arterial district was the pulmonary artery. Immunomodulation and thrombophilia were featuring challenging surgery. Conclusions: More studies are needed to shed light on the vascular complications of schistosomiasis, to ascertain the true burden of aneurysms in patients with schistosomiasis, to establish the pathophysiology of vessel damage and aneurysm formation, and to assess if there is an association between schistosomiasis and aneurysm formation in line with WHO 2021-2030 NTD Roadmap.

Aortic aneurysm lesions in Echinococcus infection. A review of cases in literature.

BACKGROUND: Parasitic infections are common in developing countries, due to poor sanitation and inadequate hygiene. Undiagnosed and untreated parasitic infections can have severe acute and chronic consequences, including cardiovascular lesions. Aortic aneurysms have been described in patients with disease of parasitological interest, including hydatidosis. AIM AND METHODS: We have described, through a review of case reports in literature, the occurrence of aortic aneurysm in patients with hydatidosis, analysing the specific clinical features, peculiarities of vascular involvement, treatment and outcome. RESULTS: A total of 9 case reports has been included. Mean age of patients was 41.7 ± 12.2 years (range 12-54). Vascular pathology presentation was chronic in the majority of cases, acute in three and subacute in one. The majority of lesions occurred in the descending thoracic aorta; one case involved the ascending aorta and arch, one the abdominal aorta. Open surgical intervention was reported in the majority of cases, endovascular treatment in two. Complications, reported twice at follow up, included one endograft stenosis and, in two cases, vertebral erosion. No deaths were reported. CONCLUSION: Aortic aneurysms can occur in patients with hydatidosis. The surgical vascular treatment of this non communicable complication of a disease of parasitological interest needs to take into account the specific clinical and surgical context in which occurs, to better target pharmacological and surgical treatment.

Stroke in Patients with Schistosomiasis: Review of Cases in Literature.

Introduction: Cerebral vascular comorbidities may occur in patients with schistosomiasis, as described in case reports. Aim and Methods. We have summarized general clinical and neurological features in patients with stroke associated with schistosomiasis, through a review of case reports in the literature. Investigation Outcomes. A total of eight case reports were retrieved. The mean age of patients was 36.42 ± 16.7 (19 to 56 years), four females, three males, and one anonymous sex. Eosinophilia was the most frequent feature at presentation, followed by cardiac abnormalities, confusion, fever, ataxia, hemiplegia, headache, urticaria, dysphasia, and memory impairment. Patients usually present with watershed infarction or intracranial vasculitis. In one case, extracranial carotid arteries presented with inflammation and stenosis. The patient's serology was positive on admission in five cases. Full neurological recovery was reported in three cases, and partial improvement in another three. In two cases, information on neurological outcomes was incomplete. Stroke in schistosomiasis can be caused by haemodynamic impairment, direct lesion to the arterial wall, vasa vasorum obliterative endarteritis, contiguity with a focus of inflamed tissue, or inflammatory intimal damage. Schistosomiasis needs to be included in the differential diagnosis of stroke in people living or coming back from endemic areas. Conclusions: Further studies addressing the noncommunicable comorbidity issues related to this condition are needed.

Hepatic aneurysm in patients with amoebic liver abscess. A review of cases in literature.

INTRODUCTION: Entamoeba histolytica is a protozoan parasite with worldwide distribution, higher in countries with poor sanitation due to its oral-faecal way of transmission. It is the causative agent of amoebic colitis and extraintestinal amoebiasis, and accounts for 40 000-100 000 deaths yearly. Amoebiasis can be complicated by liver abscess in 9% of cases. Rarely, vascular complications have been reported. Aneurysms of the hepatic artery have been described, rarely, in patients with amoebic hepatic abscess. AIM AND METHODS: Aim of our study was to describe clinical presentation, details of vascular lesions, treatment and outcome of patients with a history of amoebiasis complicated by hepatic abscess and aneurysm of hepatic vessels (key words "Amoebiasis AND aneurysm). RESULTS: Six case report were included. Mean age of patients was of 44.8 ± 8 years (range 31-52). All patients were male. Leucocytosis, anaemia, fever, abdominal pain, hematemesis, haemobilia, melena and hepatomegaly were the most frequently reported signs and symptoms. Aneurysms lesions occurred in hepatic artery or in its branches. In 2 cases rupture occurred. In 3 cases aneurysm embolization has been successful in treating arterial lesion. Spontaneous regression after abscess drainage occurred in 2 cases. Uneventful recovery was reported in the five patients with available follow up data. CONCLUSIONS: Hepatic artery aneurysms may complicate amoebiasis in patients with hepatic abscess. Notwithstanding the high burden of the disease, majorly in developing countries, only data from sporadic case report are available, suggesting underreporting bias. Further studies are needed to better understand the vascular involvement in this setting of parasitological interest.

Aortic Pathology During COVID - 19 Pandemics. Clinical Reports in Literature and Open Questions on the two Co-Occurring Conditions.

BACKGROUND: Cardiovascular involvement in SARS-CoV-2 infection has emerged as one of viral major clinical features during actual pandemic; limb arterial ischemic events, venous thrombosis, acute myocardial infection and stroke have occurred in patients. Acute aortic conditions have also been described, followed by interesting observations on cases, hypothesis, raised since the emergence of the pandemics. METHODS: a review of cases in literature of aortic pathology in patients with clinically suspected/microbiologically confirmed COVID-19 infection has been carried out to analyze anagraphic data, clinical presentation, treatment options and outcome. RESULTS: Seventeen cases have been included. Mean age of patients was 58.6 ± 15.2 years, with a male to female ratio of 12:15 (70.5% vs. 29.5%). Comorbidities were reported in 11 cases (64.7%), but in 5 cases (29.4%) no previous pathology was signaled in history. Hypertension was the most frequently reported comorbidity, in 8 cases, (47%), followed by renal pathology (17.6%), coronary artery disease (17.6%), previous aortic surgery (11.7%) and arrhythmia (11.7%); but also cerebrovascular disease, diabetes, autoimmune conditions, previous neoplasia and arrhythmia were reported once each. Fever and thoracic pain were the most frequently reported findings at presentation (8 cases, 47% each), followed by respiratory symptoms (6, 35.2%), low lymphocyte count (17.6%), features related to aneurysm rupture, ischemic stroke, abdominal pain and acute renal insufficiency. Reported aortic pathology included: type A aortic dissection (11 cases; 64.7%); new pathology of previous aortic graft (2 cases, 11.7%); 2 aortitis, 1 associated with type A aortic dissection; 1 thoraco-abdominal aortic aneurysm, 1 ruptured aortic aneurysm and 1 aortic embolizing thrombosis. Open surgery was carried out in 10 cases (58.8%), endovascular treatment in 3 (17.6%). Three patients (17.6%) died before surgery. Exitus was reported in 4 cases, with a total mortality of 23.5%. CONCLUSIONS: Acute aortic events have occurred during pandemic in patients with clinically suspected/microbiologically confirmed COVID-19 infection. Confounding clinical features at presentation, the importance of anamnestic details (as previous vascular graft implant), the observed surgical and postoperatory challenges may suggest the need to consider the implications of the possible link between acute aortic events and SARS-CoV-2 infection, in order to promptly correctly diagnose the patient and respond to specific needs.

Biofeedback stimulation in the visually impaired: a systematic review of literature.

BACKGROUND: It is estimated that approximately 1.3 billion people live with some form of distance or near visual impairment. Numerous studies have been carried out to evaluate the effects of biofeedback (BF) and establish if it could be a useful tool in vision rehabilitation for various eye diseases. OBJECTIVE: This systematic review aimed: 1) to examine the current evidence of BF efficacy for the rehabilitation of the visually impaired and 2) to describe methodological variations used in previous BF studies to provide recommendations for vision rehabilitation interventions. METHODS: A systematic review was conducted in the Medline, PubMed, Cochrane Library and Web of Science databases to collect documents published between January 2000 and May 2020. Of the 1,960 studies identified, 43 met the criteria for inclusion. The following information was collected from each study: sample size, control group, any eye disease, apparatus used, frequency and number of sessions of BF, main outcomes of training and whether a follow-up was conducted. The first group included studies published as scientific articles in peer-reviewed journals. The second group included abstracts of studies presented at peer-reviewed conferences. Publications were also grouped according to the eye disease treated. RESULTS: 25 articles and 18 peer-reviewed conference abstracts (PRCAs) were included in this review. BF stimulation is a commonly used technique for the treatment of visual impairment caused by macular disease. Most BF studies evaluate the effect of training on the preferred retinal locus (PRL), particularly with regard to fixation location and stability. Across these studies, participants who received BF intervention improved fixation stability and reading speed. High variability in the number of sessions and the duration of BF training was found. Most studies did not use a control group. CONCLUSIONS: The findings of this review present evidence for biofeedback treatment in vision rehabilitation, with improved oculomotor abilities. Currently, it is not possible to formulate evidence-based recommendations for a standard training procedure due to the poor quality of existing randomised controlled trials. High-quality studies are needed to develop standard protocols for a range of eye diseases.

Reading with central vision loss: binocular summation and inhibition.

PURPOSE: There are conflicting reports as to whether there is a binocular advantage or disadvantage when reading with central vision loss. This study examined binocular reading summation in patients with macular degeneration. METHODS: Seventy-one patients with bilateral central vision loss [mean age: 63 (S.D. = 21) years] participated. Reading performances during binocular and monocular viewing with the better eye (i.e., the eye with the best monocular visual acuity) were evaluated using different versions of the Italian MNREAD reading chart (www.precision-vision.com). Fixation stability and preferred retinal loci (PRLs) were recorded monocularly for each eye. The overall sample was split into inhibition, equality, and summation groups based on the binocular ratio (i.e., binocular/monocular) of the maximum reading speed. RESULTS: 41% of patients experienced binocular inhibition, 42% summation, and 17% equality. Binocular reading speed of the inhibition group was approximately 30 words per minute slower than those of the equality and summation groups, although the inhibition group had the best visual acuity. These patients generally had monocular PRLs in non-corresponding locations temporal or nasal to the scotoma, had the largest interocular acuity difference and lacked residual stereopsis. The three groups did not differ in fixational control, contrast sensitivity or critical print size. CONCLUSIONS: Equal proportions of patients with central vision loss show binocular reading summation and inhibition. Patients with binocular reading inhibition have poorer reading performance and different clinical characteristics than those with binocular reading summation and equality.

An exploratory cross-sectional study of subclinical vascular damage in patients with polymyalgia rheumatica.

The aim of the study was to investigate the presence of subclinical vascular damage in polymyalgia rheumatica (PMR). We enrolled PMR patients having major cardiovascular risk factors (MCVRF) and, as controls, patients with MCVRF. All underwent: color Doppler ultrasound to evaluate the common carotid intima-media thickness (IMT), the anterior-posterior abdominal aortic diameter (APAD), and the prevalence of carotid artery stenosis; the cardio-ankle vascular index (CAVI) to measure arterial stiffness together with the ankle-brachial index (ABI) to investigate the presence of lower-extremity peripheral arterial disease. Finally, we measured the serum levels of adipocytokines implicated in vascular dysfunction. As a result, 48 PMR and 56 MCVRF patients were included. An increase of IMT (1.07/0.8-1.2 vs 0.8/0.8-1.05; p = 0.0001), CAVI (8.7/7.8-9.3 vs 7.6/6.9-7.8; p < 0.0001) and APAD values (21.15/18.1-25.6 vs 18/16-22; p = 0.0013) was found in PMR patients with respect to controls. No differences were reported in the prevalence of carotid artery stenosis or ABI values between the two groups. A significant correlation between IMT and CAVI in PMR and MCVRF subjects (r2 = 0.845 and r2 = 0.556, respectively; p < 0.01) was found. Leptin levels (pg/mL; median/25th-75th percentile) were higher in PMR than in MCVRF subjects (145.1/67-398.6 vs 59.5/39.3-194.3; p = 0.04). Serum levels of adiponectin (ng/mL) were higher in PMR patients (15.9/10.65-24.1 vs 6.1/2.8-22.7; p = 0.01), while no difference in serum levels of resistin (ng/mL) was found between PMR and MCVRF subjects (0.37/0.16-0.66 vs 0.26/0.14-1.24). Our study shows an increased subclinical vascular damage in PMR patients compared to those with MCVRF, paving the way for further studies aimed at planning primary cardiovascular prevention in this population.