BACKGROUND AND OBJECTIVES

The global pandemic caused by Coronavirus Disease 2019 (COVID-19) has affected millions, with growing evidence of the potential role of ocular tissues in viral transmission. At the time of writing, local data regarding the phenomenon was limited. This study investigated external ocular manifestations in patients with COVID-19 at a referral center in the Philippines, examined correlations between demographics, systemic manifestations, and laboratory results with ocular manifestations, and determined their timing relative to systemic symptoms.

METHODS

This single-center, descriptive cross-sectional study was carried out from December 8 to 18, 2020 at the adult COVID-19 wards of the Philippine General Hospital involving 72 participants. Data collection involved relevant clinical history taking and performing gross eye examination. The prevalence of ocular manifestations was described with 95% confidence intervals. Correlations between ocular manifestations and quantitative variables were analyzed with point-biserial correlation, and associations with qualitative variables were tested using chi-square or Fisher’s exact tests.

RESULTS

Among participants, 31.9% presented with ocular manifestations with foreign body sensation as the most prevalent ocular symptom (11.1%) and conjunctival hyperemia as the most prevalent ocular finding (19.4%). The median age of patients with ocular manifestations was 41 years old with a higher prevalence in the male population (73.9%, CI=95%, p=0.001). No significant correlation was observed between presence of external ocular manifestations and the different systemic and ocular co-morbidities as well as with COVID-19 clinical classification. Among those who experienced symptoms, majority (29.2%) of the patients experienced systemic symptoms prior to the onset of ocular symptoms. Ocular complaints may present as the sole manifestation (13.9%). Several laboratory parameters were measured and only temperature and AST levels showed a low positive correlation with the presence of ocular manifestations. 

CONCLUSION

Ocular manifestations occur in roughly one third of patients with COVID-19 based on this study population. With some individuals presenting with ocular signs or symptoms as the initial and sole manifestation, healthcare practitioners must exercise caution and remain vigilant in managing patients who present as such. At the time of writing, this is the first local study investigating the different external ocular manifestations in patients with COVID-19. There is a need to pursue more robust studies and conduct more local investigations which will guide both ophthalmologists and other practitioners in strengthening existing guidelines regarding precautionary practices, clinical diagnosis, and management of COVID-19 patients.

Human ; Sars-cov-2 ; Covid-19 ; Philippines ; Adult ; Association ; Classification ; Collection ; Confidence Intervals ; Coronavirus ; Cross-sectional Studies ; Data Collection ; Demography ; Diagnosis ; Disease ; Exercise ; Eye ; Foreign Bodies ; History ; Hospitals ; Hospitals, General ; Hyperemia ; Laboratories ; Male ; Morbidity ; Ophthalmologists ; Pandemics ; Patients ; Population ; Prevalence ; Referral And Consultation ; Role ; Sensation ; Temperature ; Time ; Tissues ; Volition ; World Health Organization ; Writing

The spleen is a very hostile environment for tumor cells due to its anatomic location, blood supply, and rich immunological property – which makes it one of the most unique organ to be involved in metastatic diseases.15 Splenic metastases from non-hematologic malignancies are rare ranging from 0.6 to 7.1% base on autopsy reports of cancer patients, and 1.1 to 3.4% base on review of splenectomy cases.14 Moreover, isolated splenic metastases are more infrequent with only 31 cases reported from 1969 to October 2015.16 A splenic abscess is an unusual formation and is usually caused by hematogenous spread from an infection. Such expected frequency varies in different autopsy studies between 0.14% and 0.7%.1 Albeit rare, abscess can also result from migration of gut flora brought about by direct invasion of tumor cells from a neighboring neoplasm.17 This is a case of a 36-year-old female who came in with a history of abdominal pain, chills and fever for seven months. CT scan of the whole abdomen revealed splenic abscess with suspicion of a splenic rupture. The patient underwent exploratory laparotomy with abscess evacuation, splenectomy and double barrel colostomy and given with intravenous antibiotics. Histopathology results showed metastatic adenocarcinoma in the spleen. Thorough deliberation of her case was done and she was eventually managed as a case of Colon Cancer Stage IV and underwent chemotherapy. Splenic abscess developing from splenic metastasis from a colonic adenocarcinoma is rare and with concomitant high mortality rate. More often than not, splenic metastasis is discovered in advanced stage together with metastatic tumor in other organs while isolated splenic metastasis is even more uncommon. A splenic abscess as an initial demonstration of a colon cancer is not a common daily encounter of physicians hence a high index of suspicion coupled with sensitive and specific imaging is necessary in order to provide prompt medical and surgical intervention.

Human ; Female ; Adult: 25-44 Yrs Old ; Abdomen ; Adenocarcinoma ; Autopsy ; Colostomy ; Gastrointestinal Microbiome ; Pain ; Research Report ; Infections ; History ; Splenic Rupture ; World Health Organization ; Neoplasms ; Disease ; Fever ; Hematologic Neoplasms

OBJECTIVES: Plague remains a public health concern worldwide, particularly in old foci. Multiple epidemics of this disease have been recorded throughout the history of Iran. Despite the long-standing history of human plague in Iran, it remains difficult to obtain an accurate overview of the history and current status of plague in Iran. METHODS: In this review, available data and reports on cases and outbreaks of human plague in the past and present in Iran and in neighboring countries were collected, and information was compiled regarding when, where, and how many cases occurred. RESULTS: This paper considers the history of plague in Persia (the predecessor of today’s Iran) and has a brief review of plague in countries in the World Health Organization Eastern Mediterranean Region, including a range of countries in the Middle East and North Africa. CONCLUSIONS: Since Iran has experienced outbreaks of plague for several centuries, neighboring countries have reported the disease in recent years, the disease can be silent for decades, and the circulation of Yersinia pestis has been reported among rodents and dogs in western Iran, more attention should be paid to disease monitoring in areas with previously reported human cases and in high-risk regions with previous epizootic and enzootic activity.
Africa, Northern ; Animals ; Disease Outbreaks ; Dogs ; History of Medicine ; Humans ; Iran* ; Mediterranean Region ; Middle East ; Persia ; Plague* ; Public Health ; Rodentia ; World Health Organization ; Yersinia pestis

From cooperation between World Federation of Acupuncture-Moxibustion Societies (WFAS) and World Health Organization, works of academics and standardization, acupuncture-moxibustion education, technique service, organization development, etc., the 27-year development of WFAS since 1987 was summarized and reviewed in details. The growth of WFAS witnesses and promotes the development of acupuncture and moxibustion in the world, so by learning the experience and lessons, WFAS could have a wider path, becoming a core organization for communicating and promoting the development of acupuncture, even the traditional medicine in the world.
Acupuncture ; education ; history ; organization & administration ; standards ; Acupuncture Therapy ; history ; standards ; Global Health ; history ; History, 20th Century ; History, 21st Century ; Humans ; Moxibustion ; history ; standards ; Societies ; history ; World Health Organization

The Republic of Korea(ROK) and the World Health Organization(WHO) have done many projects successfully from 1949, in which the government of First Republic joined the WHO. However the relation between the ROK and the WHO have not been studied very much so far. The main purpose of this research, which could be done by the support of WHO, is connected with three questions. First research point would be "how could the ROK joined WHO in 1949 and what's the meaning of it? And the what's the difference in the process for the WHO between the ROK of 1949 and the DPRK(Democratic People's Republic of Korea) of 1973?" The first president of the ROK, Rhee Syngman, who had received his Ph. D.(about international politics) from Princeton University in 1910, was strongly interested in joining international institutes like UN, WHO. The ROK that could join WHO on 17 August 1949, with the approval of Assembly on 25 May 1949, was one of the founder members of the Western Pacific Region. By joining WHO, the ROK could get chance to increase the level of public health and its administration in 1950's. But the DPRK manage to became a member of WHO on 19 May 1973 and joined the South-East Asia Region. The joining of DPRK was influenced by the easing of the cold war after the Nixon Doctrine and the joining of the China(People's Republic of China). Second research point would be "What kind of roll did the WHO take in the First Republic?" Yet the public health administration of the First Republic that had been made in the period of US army military government was been strongly influenced by USA, the roll of WHO was also important in the 1950's. Last research point would be "What kind of the projects did the ROK and the WHO take part in during the period of he First Republic? How could evaluate the results?" The ROK and the WHO handled the projects including health services, communicable disease prevention and control, control of noncommunicable diseases, and protection of health. Specially for the efforts to prevent communicable disease, the WHO focused on leprosy, malaria, measles, smallpox, tuberculosis in 1950's. The First Republic could overcome the bad health condition after the Korea War successfully, supported by WHO.
History, 20th Century ; *Politics ; Public Health/*history ; Republic of Korea ; World Health Organization/*history

Fears of a potential pandemic due to A(H5N1) viruses have focussed new attention on our current vaccines, their shortcomings, and concerns regarding global vaccine supply in a pandemic. The bulk of current vaccines are inactivated split virus vaccines produced from egg-grown virus and have only modest improvements compared with those first introduced over 60 years ago. Splitting, which was introduced some years ago to reduce reactogenicity, also reduces the immunogenicity of vaccines in immunologically naïve recipients. The A(H5N1) viruses have been found poorly immunogenic and present other challenges for vaccine producers which further exacerbate an already limited global production capacity. There have been some recent improvements in vaccine production methods and improvements to immunogenicity by the development of new adjuvants, however, these still fall short of providing timely supplies of vaccine for all in the face of a pandemic. New approaches to influenza vaccines which might fulfil the demands of a pandemic situation are under evaluation, however, these remain some distance from clinical reality and face significant regulatory hurdles.
Animals ; Birds ; Disease Outbreaks ; prevention & control ; statistics & numerical data ; Global Health ; History, 20th Century ; History, 21st Century ; Humans ; Influenza A Virus, H5N1 Subtype ; isolation & purification ; Influenza Vaccines ; history ; Influenza in Birds ; epidemiology ; prevention & control ; Influenza, Human ; epidemiology ; prevention & control ; World Health Organization

PURPOSE: Most cases of papillary microcarcinomas of the thyroid (PMC) are not palpable and are clinically asymptomatic. The natural history of the microcarcinoma is unclear and remains debatable. There is continued discussion of whether thyroid microcarcinomas should be treated surgically and to what extent surgical removal should be extended. The main goal of this study was to analyze the clinical features and to determine the appropriate surgical treatment for well differentiated PMC in one lobe of the thyroid with favorable features in regard to consideration of radical surgery. METHODS: We studied 134 patients with the histological diagnosis of PMC from March 2003 to January 2006. The tumor was defined as 10 mm or less in the greatest diameter according to the World Health Organization guidelines. For all patients we confirmed the diagnosis by ultrasoundguided fine-needle aspiration biopsy (US-FNAB) preoperatively. There were 11 men and 123 women. The age at initial treatment ranged from 22 to 74 years (mean 46). Thyroid resection was lobectomy in 31 (23.1%) and total thyroidectomy (TT) in 103 (76.9%). CCND was performed routinely at the time of thyroidectomy. Lateral neck dissection was carried out in eight patients (5.9%) who had biopsy-proven metastatic cervical lymphadenopathy demonstrated clinically or by imaging. Patient records were reviewed retrospectively. Categorical variables were analyzed using the chi-square test or Fisher's exact test. Two-sided Student's t-test was used to compare paired data. RESULTS: The mean tumor size was 6.77 mm. PMC was associated in 36.6% (49/134) with lymph node metastasis, in 20.1% (27/134) with multifocality and in 26.9% (36/134) with capsular invasion. The mean tumor size differences influenced lymph node metastasis (LNM) (P<0.05). Capsular invasion (38.8%, 19/49) and multifocality (30.6%, 15/49) were associated with LNM (P=0.018, 0.022 respectively). The subdivision of primary tumors according to size (5 mm) influenced multifocality (P=0.031). The frequency of LNM, in the contralateral central compartment of patients with lesions in one lobe of thyroid, without capsular invasion, underwent TT with CCND in 1.7% (1/59). CONCLUSION: Currently, thyroidectomy with lymph node dissection has been the recommended first line treatment for microcarcinoma of the thyroid because of the high incidence of multifocality and lymph node metastasis. However, when we excluded patients with aggressive prognostic features we could successfully perform lobectomy and isthmusectomy with ipsilateral CCND based on considerations of radical surgery (98.3%, 58/59). However, subsequent surgery for contralateral nodes or lobe metastasis would not be easy and a longer follow-up period would be required to confirm our hypothesis with regard to the long term recurrence and mortality.
Biopsy, Fine-Needle ; Diagnosis ; Female ; Follow-Up Studies ; Humans ; Incidence ; Lymph Node Excision ; Lymph Nodes ; Lymphatic Diseases ; Male ; Mortality ; Natural History ; Neck Dissection ; Neoplasm Metastasis ; Recurrence ; Retrospective Studies ; Thyroid Gland* ; Thyroidectomy ; World Health Organization

BACKGROUND AND OBJECTIVES: Primary (idiopathic) pulmonary hypertension is a rare, progressive and fatal disease. It has been defined, by the World Health Organization, as a mean pulmonary arterial pressure greater than 25 mmHg at rest, or greater than 30 mmHg during exercise, without the apparent cause of secondary pulmonary hypertension. This study was performed to better understanding the clinical presentation, natural history and prognosis of primary pulmonary hypertension. SUBJECTS AND METHODS: A total of 18 patients, who were diagnosed as primary pulmonary hypertension, at three University Hospitals, were retrospectively reviewed. All patients had undergone echocardiography and cardiac catheterization. RESULTS: With the patients there was a male: female ratio of 1:8, ranging in age between 10 and 50 years. The most common presenting symptom was dyspnea on exertion, with other symptoms comprising of fatigue in 11, chest pain in 5, syncope in 3 and hemoptysis in 2. The ECG & echocardiography reflected the presence of right-sided heart enlargement. The average right ventricular systolic pressure, from Doppler echocardiography, was 73.6+/-18.8 mmHg. The mean pulmonary artery pressure and pulmonary capillary wedge pressure were 52.9+/-18.4 and 9.2+/-3.1 mmHg, respectively. The survival times were within 30 and 21 to 60 months in 9 and the remaining patients, respectively. CONCLUSION: We conclude that primary pulmonary hypertension is common in female patients in their third to fifth decades. This study also showed a poor prognosis, as in other reports.
Arterial Pressure ; Blood Pressure ; Cardiac Catheterization ; Cardiac Catheters ; Cardiomegaly ; Chest Pain ; Dyspnea ; Echocardiography ; Echocardiography, Doppler ; Electrocardiography ; Fatigue ; Female ; Hemoptysis ; Hospitals, University ; Humans ; Hypertension, Pulmonary* ; Male ; Natural History ; Prognosis ; Pulmonary Artery ; Pulmonary Wedge Pressure ; Retrospective Studies ; Syncope ; World Health Organization