Practical needs and considerations for refugees and other forcibly displaced persons with neurological disorders: Recommendations using a modified Delphi approach.

Background: There are >70 million forcibly displaced people worldwide, including refugees, internally displaced persons, and asylum seekers. While the health needs of forcibly displaced people have been characterized in the literature, more still needs to be done globally to translate this knowledge into effective policies and actions, particularly in neurology. Methods: In 2020, a global network of published experts on neurological disease and refugees was convened. Nine physician experts from nine countries (2 low, 1 lower-middle income, 5 upper-middle, 1 high income) with experience treating displaced people originating from 18 countries participated in three survey and two discussion rounds in accordance with the Delphi method. Results: A consensus list of priority interventions for treating neurological conditions in displaced people was created, agnostic to cost considerations, with the ten highest ranking tests or treatments ranked as: computerized tomography scans, magnetic resonance imaging scans, levetiracetam, acetylsalicylic acid, carbamazepine, paracetamol, sodium valproate, basic blood tests, steroids and anti-tuberculous medication. The most important contextual considerations (100% consensus) were all economic and political, including the economic status of the displaced person's country of origin, the host country, and the stage in the asylum seeking process. The annual cost to purchase the ten priority neurological interventions for the entire displaced population was estimated to be 220 million USD for medications and 4.2 billion USD for imaging and tests. Conclusions: A need for neuroimaging and anti-seizure medications for forcibly displaced people was emphasized. These recommendations could guide future research and investment in neurological care for forcibly displaced people.

Evaluation of internal limiting membrane maculorlexis in the management of macular hole

In this study, 12 eyes with full thickness macular holes with ILM peeling [group 1] were compared with another 12 eyes with the same pathology and without ILM peeling. All eyes underwent simple pars plana vitrectomy with [group 1] or without [group 2] ILM peeling with intra-vitreous gas [C3F8] or silicone oil 5000 and face down positioning for 5 days. No adjunctive therapy was used in any group. The closure and/or reopening rate, prognosis, VA and complications in both groups were compared. With good surgical skills and a relatively short follow up period, ILM peeling may not make a difference in retinal reattachment rate; however, it significantly improves the post surgical BCVA