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literaturepublisher23 · 11 months ago

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Journal of Clinical Images

Clinical Image Journal: Journal of Clinical Images accepting articles in the form of images, image case, clinical images journal, image of journal, clinical image illustrations journal, clinical research image journal, clinical research imaging journal etc. Journal paves a great platform to access the recent developments of the clinical and medical world and is employed for publishing the varied case reports & clinical images that pertains to many clinical and medical conditions. Clinical Image Journal: Journal of Clinical Images is an international peer reviewed open access journal focused on publishing the most complete, reliable source of research information, current developments, and clinically interesting, trainees and researchers in all surgical subspecialties, as well as clinicians in related fields. Clinical Image Journal: Journal of Clinical Images is internationally peer reviewed and provides major understanding of diagnosis of many diseases, their management and their therapeutic strategies that aims in improving health outcomes globally. Case reports and clinical images are required altogether areas of medicine and involves research using the human volunteers who are intended to contribute to the clinical and medical knowledge.

Journal Homepage: https://www.literaturepublishers.org/

Manuscript Submission

Authors are requested to submit their manuscript by using Online Manuscript Submission Portal:

(or) also invited to submit through the Journal E-mail Id: [email protected]

The mission of Clinical Image Journal: Journal of Clinical Images is to publish, in a timely manner, the very best clinical research around the world with special attention to the impact of medical imaging on patient care. Clinical Image Journal: Journal of Clinical Images publications cover all imaging modalities, radiology issues related to patients, policy and practice improvements, and clinically-oriented imaging physics and informatics. Clinical Image Journal: Journal of Clinical Images is a valuable resource for practicing radiologists, radiologists-in-training and other clinicians with an interest in imaging.

Papers are carefully peer-reviewed and selected by our experienced subject editors who are leading experts spanning the range of imaging sub-specialties, which include: Body Imaging- Breast Imaging- Cardiothoracic Imaging- Imaging Physics and Informatics- Molecular Imaging and Nuclear Medicine- Musculoskeletal and Emergency Imaging- Neuroradiology- Practice, Policy & Education- Pediatric Imaging- Vascular and Interventional Radiology.

Clinical Image Journal: Journal of Clinical Images Scope Case reports / Clinical Images can be prospective or retrospective and examine the effects of an intervention in more than one patient. All case reports and clinical Images submitted need to comply with the relevant reporting criteria. It is dedicated to publishing Medical Case Reports, Clinical Images, Case Series and Clinical Videos. The following classifications and topics related to it will be considered for publication in the Journal but not limited to the following fields.

Neurology Image Journal, Oncology Image Journal, Dentistry Image Journal, Surgery Image Journal, Cardiology Image Journal, Nutrition and Dietetics Image Journal, Ophthalmology Image Journal, Gastroenterology Image Journal, Internal Medicine Image Journal, Nephrology Image Journal, Palliative Care Image Journal, Physiotherapy Image Journal, Radiation Oncology Image Journal, Sleep Disorders Image Journal & Sleep Studies Image Journal, Anesthesiology Image Journal, Emergency Medicine Image Journal and Critical, Forensic Image Journal and Legal Medicine Image Journal, Infectious Disease Image Journal, Infertility Case reports, Neurological Surgery Image Journal, Obstetrics Image Journal and Gynecology Image Journal, Otolaryngology Image Journal, Pharmacology Image Journal and Therapeutics Image Journal, Physical Medicine Image Journal & Rehabilitation Image Journal, Radiology Image Journal, Dermatology Image Journal, Endocrinology Image Journal, Diabetes Image Journal & Metabolism Image Journal, Orthopedics Image Journal & Rheumatology Image Journal, Pathology- Anatomic & Clinical Image Journal, Pulmonary Image Journal Disease, Preventive Medicine Image Journal, Respiratory Medicine Image Journal, Urology Image Journal, Oral Medicine Image Journal, ENT Image Journal, Geriatric Medicine Image Journal, Maxillofacial Surgery Image Journal, Neonatology Image Journal, Nuclear Medicine Image Journal, Pain Management Image Journal, Pediatrics Image Journal, Psychiatry Image Journal, Sexual Health Image Journal, Vascular Medicine Image Journal, Family Medicine Image Journal and Public Health Image Journal, Allergy Image Journal & Immunology Image Journal, Diabetology Image Journal, Hematology Image Journal.

#Journal of Clinical Images #health #news #publisher

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literaturepublisher10 · 1 year ago

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Journal of Clinical and Medical Case Reports

Journal of Clinical and Medical Case Reports publishes clinical case reports, medical case series, medical case studies, medical case reports and clinical images for publication that fall under the scope of all clinical and medical studies. Journal of Clinical and Medical Case Reports mainly focuses on symptoms, signs, diagnosis, treatment, and follow-up of patient disease in different areas of the journal in diagnostic case report and treatment.

Journal Homepage: https://www.literaturepublishers.org/

Journal of Clinical and Medical Case Reports is a peer-reviewed open access high impact factor indexed Journal that publishes highly cited research work conducted as case reports in the medical field on various types of diseases, covering their respective clinical journal case reports, medical journal case report, clinical reports, medical case reports, clinical images, clinical case reports, journal of medical case reports and diagnosis issues.

Scope and Keywords: Journal of Clinical and Medical Case Reports, Open Journal of Clinical and Medical Case Reports, Journal of Medical Case Reports, Clinical and Medical Case Reports, Journal of Clinical Images and Medical Case Reports, Journal of Clinical Studies & Medical Case Reports, Journal of Clinical and Medical Case Studies, International Journal of Clinical and Medical Cases, Journal of Clinical Medicine, Clinical Case Reports, International Medical Case Reports Journal, Archives of Clinical and Medical Case Reports, Case Reports - A journal for medical case reports, International Journal of Clinical Case Reports and Reviews, Japanese Journal of Clinical and Medical Case Reports etc.

Journal of Clinical and Medical Case Reports Journal publishes only high quality articles from all over the world. Journal of Clinical and Medical Case Reports follows double blinded peer review process. All Editors are active and Editorial Board Members belonging to reputed institutions from abroad. They are senior faculty members, doctors, scientist and research fellows etc. Journal regularly releasing issues with good number of articles in the form of clinical images and case reports.

Scope of Clinical and Medical Case Reports Journal Authors can also find this journal in their scope on the basis these keywords: medical case reports journals, journal of medical case reports, clinical image, cardiology case reports, case reports cardiology, case reports in cardiology, case reports pediatrics, pediatrics case reports, ent journal, case reports hematology, hematology case reports, journal of otolaryngology head and neck surgery, orthopaedics & traumatology, case reports gastroenterology, case reports in gastroenterology, gastroenterology case report, clinical case report journal, International journal of surgery case reports, case images, dermatology case reports, case report in ophthalmology, case report ophthalmology, case reports in surgery, clinical image journal, journal of surgical case reports, ophthalmology case report, journal of clinical imaging science, literature publishers, cardiology case report journals, journal of traumatology, case reports in nephrology, case reports nephrology, nephrology case reports, clinical images in medicine, journal of pediatric surgery case reports, medical image analysis journals, journal of medical case reports impact factor, otolaryngology case reports, clinical case reports impact factor, case reports otolaryngology, surgical case reports, journal of orthopedic case reports, case reports in neurological medicine, best case report journals, journal of otology and laryngology and, clinical imaging impact factor etc.

Medical Case Report Journal scope also includes medical advancements with an aim towards special techniques that are implementing in all aspects of the human anatomy journal. The body image journal is running with a strong desire to provide knowledge on recent scientific research and advances in the field of Clinical and Medical Studies. The aim of the clinical imaging journal is to collect an article in the Journal of Clinical and Medical Case Reports across all clinical imaging science, medical imaging science and clinical fields, thereby integrating international medical case reports and clinical knowledge.

We feel honored to associate with and invite scientists and researchers to submit their original research/ medical case report journal/ body imaging journal/ clinical imaging journal/ clinical imaging science in International journal of clinical and medical images and case reports work for publication in literature publishers: journal of clinical and medical case studies and reports. This journal considers articles in the form of a research article, review article, short communication, opinion, Image, Case reports and commentary.

Journal of Clinical and Medical Case Reports covers all the areas of Medical Science Journal that includes: case reports in oncology, oncology case reports journal, case reports in cardiology, journal of cardiology case reports, international journal of surgery case reports, case reports in surgery, journal of surgery case reports, general surgery case report, surgical case reports journal, surgery case reports journal, journal of dermatological case reports, case reports in dermatology, case reports in endocrinology, case reports endocrinology, case reports in gastroenterology, gastroenterology case report journals, case reports in hematology, case reports in nephrology, orthopedic surgery case reports, journal of orthopedic case reports, case reports in pediatrics, journal of pediatric surgery case reports, case reports in microbiology, clinical microbiology case reports, case reports in genetics, case reports in toxicity, case reports in neuroscience, case reports in ophthalmology, case reports in andrology and gynecology, case reports in dentistry, case reports in odontology, case reports in otolaryngology, case reports in ENT, case report in head and neck surgery etc.

Journal of Clinical and Medical Case Reports encourages authors and scientists all over the world to submit their work related to various diseases, clinical trials, radiology, surgery, basic research, epidemiology, and palliative care. At a time when the research on drug delivery is taking place at a tremendous phase.

Manuscript Submission

Authors are requested to submit their manuscript by using Online Manuscript Submission Portal:

(or) also invited to submit through the Journal E-mail Id: [email protected]

#Journal of Clinical and Medical Case Reports #health #news #publishers

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diginerve · 1 year ago

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Ophthalmology Online Learning Resources

An aspiring ophthalmologist, or doctor who wishes to upgrade his or her knowledge of ophthalmology, can resort to online learning resources. The biggest merit of online resources is the fact that they can be accessed at any time, at any hour, from any place. That means that an individual can gain insights from video lectures, online journals, research publications, discussion forums, and community activities, as well as the procedures projected on video lectures, as per their convenience and flexibility. The best video lectures for ophthalmology, therefore help the aspirant gain knowledge about the latest advancements, professional practices from around the world, the latest eyecare gadgets, and more. Getting enrolled in an ophthalmology undergraduate online course paves the way for learning from video lectures in ophthalmology and opens doors to endless opportunities.

https://diginerve.blogspot.com/2023/07/ophthalmology-online-learning-resources.html

#ophthalmology undergraduate online course #Online ophthalmology courses #best ophthalmology video lectures

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literaturepublishersjournal · 1 year ago

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Video Journal: Clinical Videos Journal and Medical Videos Journal

Video Journal: Clinical Videos Journal and Medical Videos Journal accepting articles with clinical videos, medical videos, surgery videos or surgical videos for publication. Journal covers the publication of new information by publishing original research from all areas of clinical research video journal, medical research video journal and basic sciences including clinical medicine video journal, clinical trials video journal, experimental research video journal, epidemiology, preventive medicine, translational medicine and rural health. Every written manuscript submitted for publication to Clinical Video Journal must be accompanied by single or multiple videos.

Journal Homepage: https://www.literaturepublishers.org/

Journal of Clinical Videos is a publication of scholarly work in a video format. Researchers get to demonstrate their work to the audience by using a live camera shoot. Since these medical video journals let researchers showcase their work in a more visual way, the impact of their research is increased.

Links of Published Clinical Video Articles

Journals in clinical video format are broadly grouped into scientific video journals; medical video journals; technical video journals; and arts, humanity and management video journals. Each of these are further available in diverse areas including medicine, science, technology, arts, humanities, biology, management, chemistry, physics, neuroscience, engineering, genetics, cancer research, immunology and infection, developmental biology, behavior, environment, bioengineering, biochemistry, psychology, clinical skills, and many more. Even under each of these specializations, there are different sub-specializations.

For instance, under medical video journals, there are videos of cardiology video journal, oncology video journal, neurology video journal, clinical ophthalmology video journal, biomedical science video journal, cardiothoracic video journal and vascular surgery video journal, internal medicine video journal, gastroenterology video journal, pediatrics video journal, pathology video journal, radiology video journal, surgery video journal, obstetrics video journal and gynecology video journal, otolaryngology video journal, orthopedic surgery video journal, pathology video journal, etc.

Open Access Clinical & Medical Video Journal

Open access video journals are available to readers, libraries, institutions, and organizations without any barriers like payments, licensing, subscriptions and copyrights. Academicians and scientists can freely access these journals to broaden their understanding of the current happenings in their respective disciplines.

Video demonstrations enhance reproducibility and productivity, aid better and quicker understanding of experimental methods and scientific concepts; disseminate research widely; save laboratory expenses; increase learning speed in lab and class; promote consistent growth in learning outcomes, student success and STEM retention. Thus the different types of video journals including medical video journals; scientific video journals; technical video journals; and arts, management and humanity video journals are a boon to the research, student and teaching communities. You can check out and make the best use of the medical Video journal available at the Clinical Images and Case Reports Journal.

Manuscript Submission

Authors are requested to submit their Clinical Video articles only by E-mail to the Editorial Office at: [email protected]

#video journal #Clinical Videos Journal #Medical Videos Journal #clinical images #literaturepublishers

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lupinepublishers · 3 years ago

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Lupine publishers|Ophthalmic Manifestations of COVID-19 and its Association with Heparan Sulfate Receptors

Ophthalmic Manifestations of COVID-19 and its Association with Heparan Sulfate Receptors

Abstract Coronavirus disease-2019 (COVID-19) caused by a novel enveloped, positive sense, single stranded RNA virus called Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV-2) started originally in Wuhan, China. By March 2020, the disease was declared a global pandemic as the virus spread to all major countries in the world. Initially, it was believed that the virus was transmitted through inhalation of respiratory droplets from an infected person. But given the exponential increase in the number of infected people, more modes of transmission were explored. While all possible routes of transmission of this virus are still undetermined many studies implicate the eyes as the initial site of infection and conjunctivitis as an early symptom of COVID-19. In this review, we summarize various studies that suggest SARS-CoV-2’s presence on ocular surfaces and that the eyes can be a gateway for transfer of SARS-CoV-2 to the extraocular sites including the lungs. We also explore the role of heparan sulfate, a newly discovered co-receptor for the virus in ocular manifestations. Keywords: SARS-CoV-2; COVID-19; Ocular; Heparan Sulfate; ACE 2; Conjunctivitis

Introduction Coronaviruses (CoV) are a large family of enveloped RNA viruses. Structurally, a typical virion consists of envelope proteins and spike proteins protruding from its envelope surrounding the nucleocapsid. The spike proteins play an important role in binding to host cells. These viruses cause severe respiratory and enteric infections in humans as well as animals. A newly discovered strain, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), is responsible for the ongoing global outbreak of coronavirus disease 2019 (COVID-19) [1]. Initially pneumonia, cough and respiratory problems were the only reported symptoms for COVID-19 [2]. But there have been many reports of inflammation and irritation of eye in COVID-19 patients. While conjunctivitis or pink eye has not been established as an official symptom for COVID-19, few studies indicate it as an ocular manifestation of SARS-CoV-2 infection [3, 4]. To provide some history, a study conducted during the 2003 Severe Acute Respiratory Syndrome (SARS) outbreak detected SARS-CoV in tear samples of SARS patients in Singapore [5]. Insufficient eye protective equipment was considered to be one of the reasons for SARS-CoV transmission, indicating a concern that respiratory illness could be transmitted through ocular secretions [6,7]. Similar alarming situations have been raised with SARS-CoV-2 especially amongst the healthcare professionals involved with eye care and the healthcare workers present in the triage area and involved with checking symptoms of the patients and sample collection [8]. This also puts ophthalmologists and other healthcare workers at risk who are examining the COVID-19 patients manifesting conjunctivitis. An Ophthalmologist, Li Wenliang, MD died because of COVID-19. The source of transmission of the virus was later found out to be an asymptomatic glaucoma patient who visited his clinic [8]. COVID-19 is normally believed to be transmitted by respiratory droplets [9]. However, some growing body of evidence links conjunctivitis to the early stages of COVID-19 infection [4]. The ocular surface might also act as a point of entry and facilitate coronavirus transmission. Thus, to combat a global threat like COVID-19 with many asymptomatic patients, it is imperative to understand these other unexplored pathways for infection and the underlying mechanisms.SARS CoV-2 Host Cell Entry SARS-CoV-2 entry into the host cell is mediated via its spike glycoprotein S. The spike uses angiotensin-converting enzyme 2 (ACE2) as its receptor on host cells to facilitate the infection as a primary receptor [10]. SARS-CoV-2 spike protein binds with both cell surface heparan sulfate receptor and angiotensin-converting enzyme 2 (ACE2) by binding with its receptor-binding domain (RBD). Docking studies suggest a heparin/heparan sulfate-binding site adjacent to the ACE2-binding site. Both ACE2 and heparin can bind independently to spike protein in vitro, and a ternary complex can be generated using heparin as a scaffold. Electron micrographs of spike protein suggest that heparin enhances the open conformation of the RBD that binds ACE2. On cells, spike protein binding depends on both heparan sulfate and ACE2 [11]. In a study conducted by Wan and co-workers, it has been shown that the S glycoprotein of SARS-CoV-2 has a receptor binding domain (RBD) and the residue 394 (Glutamine) is responsible for binding with ACE2 receptors [12]. The S glycoprotein is activated by proteolytic cleavage by transmembrane serine protease (TMPRSS2) or the protease Furin (also known as Paired Basic Amino Acid Cleaving Enzyme) for interaction with ACE2 [13]. In TMPRSS2-negative cells, the cysteine proteases cathepsin B/L can facilitate S protein cleavage [14]. Furin acts by cleaving S1

subunit of spike protein which leads to conformational changes in S2 subunit of the spike protein. These changes expose the membrane proteins needed for virus to fuse with membrane to enter the cell as represented in Figure 1[13]. Certain human coronaviruses like HCoV-NL63 need co-receptor such as heparan sulphate (HS) in addition to ACE on host cell membrane for the virus to bind and facilitate its entry into the host cell. HS has also been indicated to play an important role in SARS-CoV’s ability to infect [15]. Studies show reduction in heparin or heparinase leads to decrease in SARS-CoV entry in cells [16]. SARS-CoV-2 displays conformational changes during binding of the virus RBD and the host cell heparan sulphate [17].Ocular Viral Transmission Globally, governments are trying to impose different preventative measures to contain COVID-19. All nations are employing nationwide lockdowns, but epidemiologic data indicate differences in disease incidence. Some countries have been successful in flattening the curve whereas even after stay at home orders, the cases are exponentially rising in some other countries. This points towards an incomplete understanding of the modes of transmission. Several studies suggest transmission modes through aerosols and fomites especially given the high transmissibility rate and some molecular characteristics of the virus [18]. Thus, to reduce disease transmission, it is necessary to research into all possible ways of disease transmission. Previous studies have demonstrated that the mucosa of the ocular surface and respiratory tract express identical receptors for certain respiratory viruses [19-22]. On the basis of the epidemiological information from earlier Coronavirus infections, various theories have been anticipated such as: a) The conjunctiva can act as a site of direct inoculation by droplets containing virus particles. b) The nasolacrimal duct acts as a route of virus infection to the upper respiratory tract. c) Haematogenic (from blood) infection of the lacrimal glands [23]. In case of SARS-CoV-2, also a respiratory virus, interaction of its spike protein with host ACE2 is responsible for viral entry as well as human-to-human transmission [9,10]. Thus, the expression of receptor ACE2 on the surface of corneal epithelium and conjunctival epithelial tissues indicates a plausible role of eye in COVID-19 transmission. But the level of ACE2 expression observed in the ocular tissues was found to be much lower than the respiratoryand kidney tissues [17]. Also, the binding ability of SARS-CoV spike protein to the ACE2 expressed on the ocular surfaces was observed to be weaker than the binding ability with the ACE2 receptors on the surface of Vero E6 cells in-vitro and the lung tissues in-vivo [20]. In this review, we suggest ocular transmission in addition to transmission by respiratory droplets, fomites and aerosols as a mode of SARS-CoV-2 transmission. Respiratory viral infections leading to development of ocular symptoms have been previously documented [4]. Scientists have hypothesized a model for eye as a gateway to transmission of virus to the respiratory tract. According to the anatomy, the mucosa of the conjunctiva and corneal epithelium and the upper respiratory tract are connected by the nasolacrimal duct [19]. When a drop of liquid is inserted into the eye the liquid is partially absorbed by the cornea and conjunctiva but mostly is passed into the nasal cavity through nasolacrimal duct and then transported to the upper respiratory tract including pharynx and trachea or else it can be taken to the gastrointestinal tract as shown in Figure 2 [24]. This ocular surface to systemic transmission hypothesis originally proposed by Belser has been further corroborated by viral inoculations of adenoviruses and

influenza viruses in the cornea of animal models including mice, rats and rabbits. And presence of viral loads in tear samples from these animals have been detected [19]. CoVs can result in a wide spectrum of ocular infections in animals. The conjunctival swabs of 90% cats infected with feline CoV (FCoV) had the FCoV antigen. This indicates the probability of ocular manifestations of SARS-CoV-2 in patients similar to the CoVs of animals [25]. The potential of infection through ocular secretions is currently unknown, and it remains unclear how SARS-CoV-2 accumulates in ocular secretions. Possible theories include direct inoculation of the ocular tissues from respiratory droplets or aerosolized viral particles, migration from the nasopharynx via the nasolacrimal duct, or even hematogenous spread through the lacrimal gland [26].Conjunctivitis and Its Correlation with Coronavirus Conjunctivitis (pink eye) is inflammation of the transparent membrane that lines the eyelid (conjunctiva) due to infections or allergies. The symptoms are watery, itchy red eyes with crusting around the eyes [27]. Many viruses can cause conjunctivitis. Unlike antibiotic eye drops for conjunctivitis caused by bacteria, viral conjunctivitis is self-healing [4]. Viral conjunctivitis is caused by DNA viruses like adenoviruses or herpesviruses and RNA viruses like picornavirus and HIV. Thus, conjunctivitis is a common ocular manifestation observed with many viruses [4]. During previous coronavirus outbreaks like SARS-CoV and HCoV-NL63, Real-time Reverse transcription polymerase chain reaction (rRT-PCR) in tears have detected the presence of virus [28, 29]. But many reports for SARS-CoV or MERS-CoV do not recognize conjunctivitis as a sign or symptom [30]. For NL63 infections, a review combined 15 studies with almost 7,000,000 patients and conjunctivitis was reported in only 17 % of one study of 300 patients [15]. Additionally, some strains of coronavirus infections displayed no viruses in their tears. Considering the history of viruses and many human case studies for SARS-CoV-2, there is a growing interest among researchers to study ocular manifestation of coronaviruses. Animal studies Animal studies can help to better understand the effects of coronavirus on eye after infecting the eye with coronavirusAnimal models and infection techniques to study specifically ocular manifestation of SARS-CoV has not been established yet. Studies for other types of coronaviruses, however, have been established. There are severe ocular manifestations due to coronaviruses in cats and mice like anterior uveitis, retinitis, vasculitis, and optic neuritis [25]. One non-peer reviewed article compared the effects of SARS-CoV-2 infection in different anatomical sites in rhesus monkey – eye (conjunctiva), lungs (trachea) and stomach. Monkeys that were only injected via trachea experienced weight loss. After 24 hours of infection, viral RNA was detected only in conjunctival swabs of monkeys infected via the eyes. These monkeys also had mild lung infection. For the infection via trachea, there was presence of SARS-CoV-2 RNA in the nasal and throat swabs of the monkey [31]. This animal study sheds light on the significance of site of manifestation of infection being related to the transmission route of the infection. Thus, using experimental designs from previous coronavirus animal models, more studies need to be conducted to understand ocular transmission and manifestation of SAR-CoV-2. Histology studies should be performed on infected eye to completely understand these ocular manifestations. Standardization of techniques needed for detection of viral conjunctivitis It has been observed that viral conjunctivitis is caused by direct inoculation of the virus in the conjunctiva for animal models. Different COVID-19 patients seem to have

variations in the conjunctivitis manifestations. One patient with COVID-19 had viral RNA in conjunctival swabs taken just after two days of infection, whereas another patient displayed bilateral conjunctivitis for 21 days after the infection. Another case study report had a COVID-19 patient with conjunctivitis but with no viral RNA in tears [32]. These studies show the diversification and differences in these ocular manifestations patient to patient. Thus, more sensitive techniques need to be adapted to track virus induced conjunctivitis for more accurate data. Different instruments have been used to analyze or detect viral RNA in patients. One study collected tear using a Schirmer strip and analyzed viral RNA in tears by rRT-PCR. They collected samples for 3 weeks from the onset of infection [26]. In this study, one patient had conjunctivitis and viral RNA was detected in tears. Another study used swab to collect conjunctival secretions from lower fornix of the eye [33]. They also collected tear data from the lower fornix. In some other studies, tear samples were collected from lower fornix and conjunctival scraping from lower palpebral conjunctiva. The eyelids were everted and then the lower fornixes were swiped with sterile cotton swabs to collect the samples. No topical anesthesia was given. Another study collected tears randomly on nine days and 19.4 days after infection [5]. While three positive cases were found in the 9-day cohort, negative results were observed in 19.4 days sample set. The available data shows very low number of cases having ocular manifestations of COVID-19. Additionally, the tear or conjunctival swab samples tested positive for SARS-CoV-2 in a single study was not significant. Therefore, a more standardized method for detection of SARS-CoV-2 in tear samples is required. By testing of large number of samples a data can be generated to provide better understanding of ocular manifestation of COVID-19. Masaki Imai et al., suggest that Syrian hamsters are susceptible to SARS-CoV-2 replicating efficiently in lungs and causing severe pathological lesions [34]. They also reported that SARS-CoV-2 can replicate in the brain or olfactory bulb of hamsters but failed to detect viral antigens in these regions. Chan et al. also demonstrated use of Syrian hamster model for SARS-CoV-2 transmission studies [35]. Human case studies In case of the ongoing pandemic COVID-19, there have been multiple reports of conjunctivitis during initial stages of the infection. Recently, a woman with COVID-19 was reported to have unilateral conjunctivitis with other symptoms like cough and nasal congestion. Her initial diagnosis was presumed to be herpetic keratoconjunctivitis. Antiviral treatment for herpes had no effect in reducing the symptoms and the unilateral conjunctivitis remained for seven days. She was tested positive for SARS-CoV-2 after seven days. The laboratory diagnosis revealed the patient was weakly positive for SARS-CoV-2 and was found negative for other secondary bacterial infections [36]. There was another similar case where the patient initially diagnosed with conjunctivitis, reported fever symptoms two days later. On testing, the patient was found to be SARS-CoV-2 positive [37]. On January 22, 2020, a Chinese respiratory specialist who visited Wuhan as a member of the national expert panel on pneumonia claimed that he was infected by SARS-CoV-2 despite being fully gowned with a protective suit and N95 respirator. His first clinical manifestation was unilateral conjunctivitis, followed by fever and catarrhal symptoms 2 or 3 h later. It was postulated that SARS-CoV-2 probably first infected the conjunctiva, then spread and caused viral pneumonia [38]. However, in an another study by Zhou and

colleagues, it was reported that conjunctivitis was identified only in one patient out of 63 COVID-19 cases and 4 suspected COVID-19 cases. Conjunctivitis was also the first symptom of SARS-CoV-2 infection in this patient. However, RT-PCR in conjunctival swab samples was positive for SARS-CoV-2 RNA from only one COVID-19 patient without conjunctivitis. This patient had no ocular symptoms. SARS-CoV-2 RNA was not detected in conjunctival swab in another similar case study of an anesthesiologist with COVID-19 and conjunctivitis. Her ocular symptoms occurred soon after performing tracheal intubation for a patient who was confirmed as having COVID-19 later, and this was followed by fever and cough. Unfortunately, the personal protections used by this anesthesiologist during the tracheal intubation procedures were only a surgical mask, cap, and gloves, without a gown, face shield or goggles. Her five colleagues were also infected by the same patient, yet none of them exhibited any ocular complications [39]. Zhang and colleagues, reported conjunctivitis in two patients out of 72 laboratory-confirmed COVID-19 cases; however, SARS-CoV-2 was detected in conjunctival swab samplesby rRT-PCR in only one patient who was a nurse working in the Emergency Department. This patient presented with excessive tearing and redness in both eyes, which were typical ocular manifestations of viral conjunctivitis, accompanied by a moderate fever of 38.2 °C that occurred 1 day earlier. SARS-CoV-2 rRT-PCR tests for the conjunctival and oropharyngeal swabs sampled 2 days after the onset of fever was positive, but for those sampled 9, 18, and 20 days after the onset of fever were all negative [40]. Xia and colleagues reported unilateral conjunctivitis in one patient out of 30 confirmed COVID-19 cases; conjunctival swabs sampled from this patient 3 and 5 days after the onset of COVID-19 were both positive for SARS-CoV-2 by rRT-PCR, whereas 58 conjunctival swab samples from the other 29 COVID-19 patients were all negative for SARS-CoV-2. However, SARS-CoV-2 was not isolated and cultured in the conjunctival swab samples from the COVID-19 patient with conjunctivitis. In contrast, 55 of the 60 sputum samples from 30 COVID-19 cases showed positive rRT-PCR results for SARS-CoV-2 [41]. Meta analytical studies Although, ocular manifestations of COVID-19 in form of conjunctivitis are overall rare in the published literature. Only 9 (0.8%) out of 1,099 patients from 552 hospitals across 30 provinces in China were reported to have “conjunctival congestion.” [42]. A recent case series reported ocular symptoms in 12 (31.6%) of 38 hospitalized patients with COVID-19 in Hubei province, China [43]. These patients had conjunctival hyperemia (3 patients), chemosis (7 patients), epiphora (7 patients), or increased secretions (7 patients). Of note is that one patient who had epiphora presented with epiphora as the first symptom of COVID-19. Of those with ocular manifestations, 2 (16.7%) patients had positive results of SARS-CoV-2 on rRT-PCR by a conjunctival swab as well as by nasopharyngeal swabs. Only one patient in this study presented with conjunctivitis as the first symptom. The authors noted that patients with ocular symptoms had higher white blood cell and neutrophil counts, C-reactive protein, and higher levels of procalcitonin and lactate dehydrogenase compared to patients without ocular abnormalities [43]. Similarly, in an another cross sectional study, out of 535 patients, 27 patients (5.0%) showed congestion in conjunctiva and 4 patients showed conjunctival congestion as the early symptom. The mean time period of conjunctival congestion was 5.9 ± 4.5 days [SD]. The other ocular symptoms, including increased conjunctival secretion, ocular pain, photophobia, dry eye

and tearing, were also found in patients with conjunctival congestion. Notably, hand–eye contact was independently correlated with conjunctival congestion in COVID-19 patients. We also found that some COVID-19 patients had chronic eye diseases, including conjunctivitis (33, 6.2%), xerophthalmia (24, 4.5%) and keratitis (14, 2.6%). Similar to the published studies, the most common clinical symptoms were fever, cough and fatigue. A total of 343 patients (64.1%) had positive SARS-CoV-2 detection in nasopharyngeal swabs [44].In a comparison of the interaction between the animal-to-human transmitted coronaviruses (SARS-CoV-1, SARS-CoV-2, MERS-CoV, CoV-229E, NL63, OC43, HKU1) and the eye by Sharif et al., the limit for detection of viral RNA in ocular discharge was 0–8% for SARS-CoV-1 and 0–5.3% for SARS-CoV-2, while no reports were found for other coronaviruses. Ocular manifestations have been encountered for NL63 and SARS-CoV-2. Ocular clinical symptoms in the form of conjunctivitis/conjunctival congestion were mainly detected in 65 (3.17%) out of 2048 reported patients with COVID-19 (range of 0.8–32%). Eye symptoms were not reported for the other coronaviruses [45].On 20th Mar 2020, Sarma, et al. screened 5 different literature databases (PubMed, Google Scholar, EMBASE, Medrixv, and BioRixv). In their systematic review and meta-Analysis, authors included studies about the ocular manifestation of SARS-COV-2 patients were without language restriction. This study concluded that 3.17% of patients show ocular manifestation. However, only 1.949% of patients show tear/conjunctival swab RT-PCR positivity. However, in spite of presence of the virus in the ocular fluid, only 33.3% showed sign of conjunctivitis/conjunctival chemosis or red eye. Again vice versa, i.e. among patients with COVID-19 associated conjunctivitis/red eye, only 28.65% showed evidence of presence of the virus in ocular fluid [46]. Loffredo et al. evaluated the frequency of conjunctivitis in patients affected by severe and non-severe COVID-19 infection according to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analysis) only on clinical studies identified by searching Pubmed, ISI Web of Science, SCOPUS, and Cochrane electronic databases. On 5th Apr 2020, authors included 1,167 COVID-19 patients in their meta-analysis. The rate of conjunctivitis was 1.1%; it was 3% and 0.7% in severe and nonsevere COVID-19 patients, respectively. The meta-analysis showed that patients with severe COVID-19 infection had, at admission to the hospital, increased incidence of conjunctivitis (odds ratio: 3.4; 95% confidence interval:1.1-10.2; P = .030) [47]. Siedlecki, et al. used the PubMed.gov for searching relevant articles. On 16th Apr 2020, authors identified 21 articles on the ophthalmological aspects of COVID-19 were identified. Of these, 12 (57.1%) were from Asia, 6 (28.6%) were from the United States of America, and 3 (14.3%) were from Europe. There were 5 (23.8%) original studies, 10 (47.6%) letters, 3 (14.2%) case reports, and 3 (14.2%) reviews [48]. On 29th May 2020, Emparan et al. published a structured review on COVID-19 and ophthalmology using PubMed, ScienceDirect, LILACS, SciELO, the Cochrane Library, and Google Scholar as electronic databases. The Oxford Center for Evidence-Based Medicine 2011 Levels of Evidence worksheet was employed by authors for quality assessments. More than 1,000 manuscripts were identified in the research; only 26 records were included in the qualitative synthesis and of these only 17 were classified as level 5 within the classification system of the Oxford CBME methodology, the rest were level 4 [49]. Lastly, on 16th Jun 2020, Torres-Costa et al. reviewed the most relevant articles together with the official

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crimsonpublishers · 5 years ago

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Macular Abnormality after Successful Surgery for Idiopathic Macular Hole Assessed Using Optical Coherence Tomography | Crimson Publishers

Macular Abnormality after Successful Surgery for Idiopathic Macular Hole Assessed Using Optical Coherence Tomography by Nazimul Hussain in Medical & Surgical Ophthalmology Research

Purpose: Macular changes following Internal Limiting Membrane peeling after successful Macular hole closure using optical coherence tomography.

Methods: 5 eyes of 5 patients were included in the study. The inclusion criteria were idiopathic full thickness macular hole and completed at least 6 months follow up. All patients underwent optical coherence tomography assessment before and after surgery until 6 months. Macular thickness and morphology map was analyzed before and after surgery.

Results: There were 3 males and 2 females. The age range from 45 to 59 years. Conspicuous irregular surface of the inner retina on Optical Coherence Tomography surface topography was evident in all eyes at 6 months. This was also associated with downward slope of the temporal macula seen on surface topography. There was trend towards decrease in subfield thickness especially in the T1, S1, I1 and N1 6 months after surgery. The average decrease was -60.4 microns in T1, -20.4 microns in S1, -13.0 microns in I1 and -23.4 microns in N1.

Conclusion: In this small case series brilliant blue assisted ILM peeling after successful macular whole closure showed evidence of decrease in macular thickness in all first subfield quadrant and downward slope of the temporal macula as well as conspicuous irregularity of the inner retina.

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literaturepublisher · 3 years ago

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Genetics and Molecular Biology case reports journal

The Journal of Clinical Images and Case Reports is an open-access journal that publishes case reports in each case of genetics. The case report in genetics includes research on the structure and potential of genes; Physical effects of causal factors, different parts of heredity as well as different parts of heredity. Genetic research includes different characteristics of DNA and chromosomes, genetic expression, generation and heredity, recombination and genetic relationships, genomics and DNA sequence.

Genetic case reports publish case reports and case arrangements that focus on diseases caused by inherited traits or genetic diversity in people and families. The case report in Genetics and Genomics is an open-access publication planned to look at how genetic changes in clear genes affect phenotypes and how new data can be used to improve treatment.

Submit your Case Reports in genetics via Online Submission at: http://www.literaturepublishers.org/submit.html

Or as an e-mail attachment to the Editorial Office at E-mail id: [email protected]

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#The Journal of Clinical Images and Case Reports is an open-access journal that publishes case reports in each case of genetics. The case rep #case reports in Microbiology #Clinical Microbiology Case Reports #case reports in Genetics #Case Reports in Toxicity #case reports in Neuroscience #case reports in Ophthalmology

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juniperpublishersophthalmology · 5 years ago

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Prevalence and Comparison of Visual Acuity Charts in School Going Children with Low Vision in Garhwal Himalayan Region-Juniper Publishers

Abstract

Aim: To compare the effectiveness of visual acuity charts used in school going children with Low Vision.

Materials and Methods: Two groups of 40 each of the children age less than 15 years of age, 40 each in study and control group attending the out patients department were selected after fulfilling the inclusion criteria. All the children were tested with Snellen’s and Lea’s symbol chart. The response of each child with both type charts was recorded. Testing of both groups was done with and without correction.

Results: In groups, female preponderance, 24(60%) in study group, 22(55%) were female children in control group. Majority of childrenin study group had refractive error (40%) and amblyopia (37.5%) while in control group 60% of children were found to have myopia. In control group, before correction, visual acuity was more than 6/18 in 13 (32.5%) children in Snellen’s chart and 22 (55%) children in Lea’s chart while 27 (67.5%) children were less than 6/18 in Snellen’s chart, 18 (45%) children in Lea’s chart. In study group, before correction visual acuity was less than 6/18 in 37 (93.2%) in Snellen‘s chart and 32 (79.4%) children in Lea’s chart while after correction the visual acuity was more than 6/18 in (17) 41.3% of cases in Snellen‘s chart and (30) 75.8% of cases in Lea’s chart.

Conclusion: Visual performance depends not only on size and distance, but also on contrast, illumination, and arrangement of targets. Study also concluded myopia and astigmatism is the commonest refractive error among school going children.

Introduction

Vision or visual perception is the complex integration of light sense, form sense, contrast sense and colour sense. Visual acuity measurement involves the determination of a threshold level of vision. Visual acuity is represented as the reciprocal of the minimal angle of resolution (the smallest letters resolved) at a given distance at high contrast. Visual acuity testing especially in low vision depends on targets, distance, lighting, background, contrast, ocular condition, concentration and intellectual level of the patients. Selection of a test is dependent on ability to respond, developmental age and time of testing. Type of tests used, therefore, will modify responses elicited. This is true in children especially in those with low vision [1]. Different types of visual acuity charts which are using now a days to Snellens acuity chart, Lea symbols test, Bailey lowie chart, ferris Log MAR charts, Wateloo charts, HOTV tests, Landolts test types and Lighthouse flash card test.

Aim

To compare the effectiveness of visual acuity charts used in school going children with Low Vision.

Materials and Methods

This is the prospective and comparative non randomized study done in outpatient department of a tertiary eye care centre over a period of 1 year. Two groups of 40 each of the children attending the Pediatric outpatients department were selected. 40 were included as control group of the children with low vision while 40 were included in the study group. All the children in both the groups were tested with Snellen’s chart and Lea’s symbol chart. Chart used was according to their developmental age. Those in the low vision group were tested at different distances also. The response of each child with both type charts was recorded. Testing of both groups was done by the same person and both groups were tested with and without correction.

Inclusion criteria

Both sexes

Children with age less than 15 years

All normal and refractive error children

Children with low vision

Exclusion criteria

Children above 16 years

Children with multi handicap

Infants.

Basic Protocol

A standard protocol was used to collect and document all the details regarding the cases included in this study. Detailed information about the history and complaints of the patients were taken. This included the type of visual problems, duration of symptoms and any history of predisposing factors like refractive errors, family history, systemic disease etc.,

Data collection

Data includes demographic details of children (age, sex,), type of refractive error, and duration of symptoms, prior history of using glasses, surgery and visual acuity at presentation were collected. Complete ocular examination details of each patient such as visual acuity for distant vision (checked with Snellen’s acuity chart and Lea’s symbol chart), Slit lamp examination, fundus examination (done with +90D lens) and binocular indirect ophthalmoscopy, were recorded. Data regarding subjective correction were also noted. Visual acuity was measured before and after correction with Snellen’s chart and Lea’s symbol chart was also noted.

Procedure of testing in Snellen’s chart

For testing distant visual acuity, the patient was seated at a distance of 6 m from the Snellen’s chart, so that the rays of light are practically parallel and the patient exerts minimal accommodation. The charts were properly illuminated not less than 20 foot-candles. The patient was asked to read the chart with each eye separately and the visual acuity was recorded as a frication, the numerator being the distance of the patient from the letters and the denominator being the smallest letters accurately read. When the patient was able to read up to 6 m the visual acuity was recorded as 6/6, which is normal. Similarly, depending upon the smallest line that the patient can read from the distance of 6m, his or her vision was recorded as 6/9, 6/12, 6/18, 6/24, 6/36, 6/60. If one cannot see the top line from 6m, he or she was asked to slowly walk towards the chart till one can read the top line. Depending upon the distance at which one can read the top line; the vision was record as 5/60, 4/60, 3/60, 2/60, 1/60.

If the patient was unable to read the top line even from 1m, he or she was asked to count fingers of the examiner. His or her vision was recorded as CF-3, CF-2, CF-1, or CF close to face, depending upon the distance at which the patient was able to count fingers. When the patient failed to count fingers, the examiner moved his or her hand close to the patient’s face. If one can appreciate the hand movements, the examiner noted whether the patient can perceive light or not, if yes, vision was recorded as projection of If the patient was unable to read the top line even from 1m, he or she was asked to count fingers of the examiner. His or her vision was recorded as CF-3, CF-2, CF-1, or CF close to face, depending upon the distance at which the patient was able to count fingers. When the patient failed to count fingers, the examiner moved his or her hand close to the patient’s face. If one can appreciate the hand movements, the examiner noted whether the patient can perceive light or not, if yes, vision was recorded as projection of

Procedure of testing in Lea’s chart

The child was allowed to stand or sit at a table with the response card in front, eyes at a 10‑foot distance from the chart. The child must be conditioned to match symbols by pointing to the same symbol on the response card as was being shown with a flash card or pointed to on the chart. Begin screening with one person holding an occluder over the child’s left eye, another person pointed to the symbols on the Lea wall chart. The screener pointed to the symbols must be careful not to cover the box around the symbols as this could affect the results of the test. The child should point to the corresponding symbol on the response card. Start with the top line of the chart and continue downward showing one letter per line. If the child reaches the bottom line, show the remaining three symbols. If the child misses any of the symbols, go to the line above and show four different symbols in that line. If the child matches them correctly, proceed downward. To receive credit for a line, the child must correctly match each of the four different symbols on the line. The number recorded as the visual acuity is the smallest line the child can read correctly. The procedure is repeated for the left eye.

Results

This prospective and comparative study was conducted at the tertiary eye care hospital over a period of one year between May 2012 to April 2013. 160 eyes of 80 patients with refractive errors were included in this study.

Age distribution

In control group (normal children), 6 of 40 (15%) were 0-5 age group, and 9 (22.5%) children were 6-10 age group and 25 (62.5%) children were 11-15 age group (Table 1).

In study group (low vision children), 4 of 40, (10%) children were 0-5 age group and 9 (22.5%) children were 6-10 age group and 27 (67.5%) children were 11-15 age group (Table 1).

Sex distribution

In control group, 16 of 40 (40%) were male children and 24(60%) were female children (Table 2).

In study group, 18 of 40 (45%) were male children and 22(55%) were female children (Table 2).

Diagnosis of low vision

In study group, 16 of 40 (40%) had refractive errors and 15 (37.5%) children had amblyopia and 5 (12.5%) children had corneal disorders and 2 (5%) children had glaucoma (Table 3).

Type of refractive errors

In control group, of the 40 children, 24 were found to be myopia (60%), hypermetropia in 2 (5%) and astigmatism in 14 (35%) children.

In study group, of the 40 children, it was found that myopia in 24 (60%), hypermetropia in 10 (25%) and astigmatism in 6 (15%) children. (Table 4).

Visual acuity

Control group:

a) Before correction: In the control group, of 40 children, visual acuity was more than 6/18 in 13 (32.5%) children in Snellen’s chart and 22 (55%) children in Lea’s chart. 27 (67.5%) children were less than 6/18 in Snellen’s chart, 18 (45%) children in Lea’s chart (Table 5).

b) After correction: In the control group of 40 children had visual acuity was more than 6/18 in 40 (100%) children in both Snellen’s and Lea’s chart (Table 5). There was different in visual acuity with different charts in 22.5% of cases before correction. Visual acuity did not differ between charts, in all cases after correction.

Study group:

a) Before correction: In the study group, out of 40 cases, the visual acuity was more than 6/18 in 3 (6.8%) children in Snellen’s chart, 8 (20.6%) children in Lea’s chart. Visual acuity was less than 6/18 in 37 (93.2%) children in Snellen‘s chart and 32 (79.4%) children in Lea’s chart (Table 6).

b) After correction: In the study group, out of 40 children, the visual acuity was more than 6/18 in (17) 41.3% of cases in Snellen‘s chart and (30) 75.8% of cases in Lea’s chart. Visual acuity was less than 6/18 in 23 (58.7%) children in Snellen’s chart and 10 (24.2%) children in Lea’s chart (Table 6).

Discussion

This prospective and comparative study was conducted in the tertiary eye care hospital from May 2014 to February 2015. 160 eyes of 80 patients with refractive errors were included in this study. Niroula et al [2] reported that distribution of myopia was found to be higher (4.05%) than the hyperopia (1.24%) and astigmatism (1.14%). Niroula et al [2] in the present study, myopia was in 24 (60%), hypermetropia in 2 (5%) and astigmatism in 14 (35%) children. In study group out of 40 children we found to be myopia in 24 (60%), hypermetropia in 10 (25%) and astigmatism in 6 (15%) children. Tong et al reported bearing in mind that the visual acuity measurements were performed by two different groups of professionals, visual acuity screening using the ETDRS method appears to be more accurate than the simplified charts for the detection of myopia or any refractive errors in children. Tong et al [3] In present study Lea’s symbol chart was found to be better than Snellen’s chart by measuring the accurate visual acuity among the normal as well as the low vision children. Dobson et al [4] reported correlation between visual acuity results obtained with the two charts was high. There was no difference in absolute inter-eye acuity difference measured with the two acuity charts. However, on average, Lea’s Symbols acuity scores were one log MAR line better than Bailey-Lovie acuity scores, and this difference increased with worse visual acuity. Cyert L et al [5], Lueder G [6] In present study also there was no much difference in normal children comparatively than low vision children.

Tong et al [7] studied modified ETDRS visual acuity chart can be used to predict refractive errors in school children in Singapore in a sensitive and specific manner using a referral criterion of worse than or equal to 0.28 logarithm of the minimum angle of resolution. Dobson et al [8] reported in the comparitive visual acuity study of young children, in whom the primary source of reduced visual acuity was astigmatism-related amblyopia, the Lea’s symbols chart produced visual acuity scores that were about 0.5 lines better than visual acuity scores obtained with ETDRS charts. Dobson et al [8] Similarly, in the present study also Lea’s symbol visual chart produced visual acuity scores better than the Snellen’s chart especially in low vision children. Uzma et al [9] found out that myopia was present in almost 51% of the study population, she stressed on provision of health education, periodic visual screening programs, and primary eye care by trained health care personnel in the elementary schools will prevent the prevalence of refractive errors and common ocular diseases in school children. Gupta et al [10] found out that refractive errors were the most common ocular disorders among school children of age 6-16 years.

Dandona et al [11] in his study stated that the prevalence of uncorrected refractive error, especially myopia, was higher in urban children. He further emphasized on the eye screening of school children. However, the approach used may be different for urban and rural school children [11,12].

Conclusion

Visual performance depends not only on size and distance, but also on contrast, illumination, and arrangement of targets. These factors, affected in low vision, may modify responses during testing, thus giving high false negatives. Use of appropriate charts is, therefore, mandatory while assessing children with low vision. This study also concluded myopia and astigmatism is the commonest refractive error among school going children. Lea’s chart is easier to measure visual acuity in low vision school going children than the Snellen’s chart. It was observed that the visual acuity differed with different charts, in low vision cases, before and after correction. The difference is dependent on the individual’s absolute level of visual acuity. Visual acuity is easy to measure in children by Lea’s chart.

Acknowledgement

The authors are thankful to Dr. Amjad Salman, Dr. Preeti Pant and Divyam Pandey for their timely help.

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generalcreatortiger · 4 years ago

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Scientists said claims about China creating the coronavirus were misleading. They went viral anyway.

Craig Timberg

Feb. 13, 2021 at 7:48 a.m. GMT+8

Scientists from Johns Hopkins, Columbia and other leading American universities moved with rare speed when a Chinese virologist, Li-Meng Yan, published an explosive paper in September claiming that China had created the deadly coronavirus in a research lab.

The paper, the American scientists concluded, was deeply flawed. And a new online journal from MIT Press — created specifically to vet claims related to SARS-CoV-2 — reported Yan’s claims were “at times baseless and are not supported by the data” 10 days after she posted them.

But in an age when anyone can publish anything online with a few clicks, this response was not fast enough to keep Yan’s disputed allegations from going viral, reaching an audience in the millions on social media and Fox News. It was a development, according to experts on misinformation, that underscored how systems built to advance scientific understanding can be used to spread politically charged claims dramatically at odds with scientific consensus.

Yan’s work, which was posted to the scientific research repository Zenodo without any review on Sept. 14, exploded on Twitter, YouTube and far-right websites with the help of such conservative influencers as Republican strategist Stephen K. Bannon, who repeatedly pushed it on his online show “War Room: Pandemic,” according to a report published Friday by Harvard researchers studying media manipulation. Yan expanded her claims, on Oct. 8, to blame the Chinese government explicitly for developing the coronavirus as a “bioweapon.”

Online research repositories have become key forums for revelation and debate about the pandemic. Built to advance science more nimbly, they have been at the forefront of reporting discoveries about masks, vaccines, new coronavirus variants and more. But the sites lack protections inherent to the traditional — and much slower — world of peer-reviewed scientific journals, where articles are published only after they have been critiqued by other scientists. Research shows papers posted to online sites also can be hijacked to fuel conspiracy theories.

Yan’s paper on Zenodo — despite several blistering scientific critiques and widespread news coverage of its alleged flaws — now has been viewed more than 1 million times, probably making it the most widely read research on the origins of the coronavirus pandemic, according to the Harvard misinformation researchers. They concluded that online scientific sites are vulnerable to what they called “cloaked science,” efforts to give dubious work “the veneer of scientific legitimacy.”

“They’re many years behind in realizing the capacity of this platform to be abused,” said Joan Donovan, research director at the Harvard Kennedy School’s Shorenstein Center on Media, Politics and Public Policy, which produced the report. “At this point, everything open will be exploited.”

Yan, who previously was a postdoctoral fellow at Hong Kong University but fled to the United States in April, agreed in an interview with The Washington Post that online scientific sites are vulnerable to abuse, but she rejected the argument that her story is a case study in this problem.

Rather, Yan said, she is a dissident trying to warn the world about what she says is China’s role in creating the coronavirus. She used Zenodo, with its ability to instantly publish information without restrictions, because she feared the Chinese government would obstruct publication of her work. Her academic critics, she argued, will be proven wrong.

“None of them can rebut from real, solid, scientific evidence,” Yan said. “They can only attack me.”

Zenodo acknowledged that the furor has prompted reforms, including the posting of a label Thursday above Yan’s paper saying, “Caution: Potentially Misleading Contents” after The Washington Post asked whether Zenodo would remove it. The site also prominently features links to critiques from a Georgetown University virologist and the MIT Press.

“We take misinformation really seriously, so it is something that we want to address,” said Anais Rassat, a spokeswoman for the European Organization for Nuclear Research, which operates Zenodo as a general purpose scientific site. “We don’t think taking down the report is the best solution. We want it to stay and indicate why experts think it’s wrong.”

But mainstream researchers who watched Yan’s claims race across the Internet far more quickly than they could counter them have been left troubled by the experience — newly convinced that the capacity for spreading misinformation goes far beyond the big-name social media sites. Any online platform without robust and potentially expensive safeguards is equally vulnerable.

“This is similar to the debate we’re having with Facebook and Twitter. To what degree are we creating an instrument that speeds disinformation, and to what extent are you contributing to that?” said Stefano M. Bertozzi, editor in chief of the MIT Press online journal “Rapid Reviews: COVID-19,” which challenged Yan’s claims.

Bertozzi added, “Most scientists have no interest in getting in a pissing match in cyberspace.”

Catch up on the most important developments in the pandemic with our coronavirus newsletter. All stories in it are free to access.

Coronavirus fuels prominence of online science sites

Online scientific sites have been growing for more than a decade, becoming a vital part of the ecosystem for making and vetting claims across numerous academic fields, but their growth has been supercharged by the urgency of disseminating new discoveries about a deadly pandemic.

Some of the best-known of these sites, such as medRxiv and bioRxiv, have systems for rapid evaluation intended to avoid publishing work that doesn’t pass an initial sniff test of scientific credibility. They also reject papers that only review the work of others or that make such major claims that they shouldn’t be publicized before peer review can be conducted, said Richard Sever, co-founder of medRxiv and bioRxiv.

“We want to create a hurdle that’s high enough that people have to do some research,” Sever said. “What we don’t want to be is a place where there’s a whole bunch of conspiracy theories.”

Online publishing sites generally are called “preprint servers” because many researchers use them as a first step toward traditional peer review, giving the authors a way to make their work public — and available for possible news coverage — before more thorough analysis begins. Advocates of preprint servers tout their ability to create early visibility for important discoveries and also spark useful debate. They note that traditional peer-reviewed journals have their own history of occasionally publishing hoaxes and bad science.

“It’s very funny that everyone is worrying about preprints given that, collectively, journals are not doing a great job of keeping misinformation out,” Sever said.

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He and other proponents, however, acknowledge risks.

While scientists debate — and sometimes refute — flawed claims by one another, nonscientists also scan preprint servers for data that might appear to bolster their pet conspiracy theories.

A research team led by computer scientist Jeremy Blackburn has tracked the appearance of links to preprints from social media sites, such as 4chan, popular with conspiracy theorists. Blackburn and a graduate student, Satrio Yudhoatmojo, found more than 4,000 references on 4chan to papers on major preprint servers between 2016 and 2020, with the leading subjects being biology, infectious diseases and epidemiology. He said the uneven review process has “lent an air of credibility” to preprints that experts might quickly spot as flawed but ordinary people wouldn’t.

“That’s where the risk is,” said Blackburn, an assistant professor at Binghamton University. “Papers from the preprint servers show up in a variety of conspiracy theories … and are misinterpreted wildly because these people aren’t scientists.”

Jessica Polka, executive director of ASAPbio, a nonprofit group that pushes for more transparency and wider use of preprint servers, said they rely on something akin to crowdsourcing, in which comments from outside researchers quickly can identify flaws in work, but she acknowledged vulnerabilities based on the extent of review by server staff and advisers. A recent survey by ASAPbio found more than 50 preprint servers operating — and nearly as many review policies.

And the survey didn’t include Zenodo, which, Polka said, should not be considered a preprint server given its broader mission. Rather, she said, it’s an online repository that happens to host some preprints, as well as conference slides, raw data and other “scientific objects” that anyone with an email address can simply upload. Zenodo has none of the vetting common to major preprint servers and isn’t organized to easily surface critiques or conflicting research, she said.

“Without that kind of context, a preprint server is even more vulnerable to the spread of disinformation,” Polka said. But she added, in general, “Preprint servers do not have the resources to be arbiters of whether something is true or not.”

Yan defends her work

Yan said in her interview with The Post that Zenodo’s openness is what drove her decision to use the site. She had initially submitted her paper to bioRxiv because as a researcher whose work has appeared in Nature, the Lancet Infectious Diseases and other traditional publications, she knew that this preprint server would appear more legitimate to other scientists.

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Yan has a medical degree from Xiangya Medical College of Central South University and a PhD in ophthalmology from Southern Medical University — both in China — and was a postdoctoral fellow at the University of Hong Kong, she said. That university announced she was no longer affiliated with it in July, following an initial appearance on Fox News, saying in a statement that her claim about the origin of the coronavirus “has no scientific basis but resembles hearsay.”

After she fled Hong Kong, she harbored deep suspicions about that government’s potential to block publication of her work, she said. When she checked bioRxiv 48 hours after making her submission, the site appeared to have gone offline, Yan said. Fearing the worst, she withdrew the paper and uploaded it to Zenodo.

Sever, the bioRxiv co-founder, said he could not comment on an individual submission but said that, despite occasional glitches, he was aware of no “prolonged outage” on the site during mid-September and no sign that the Chinese, or anyone else, had hacked it.

For Yan’s paper on Zenodo, she did not list an academic affiliation, as is customary for research. Instead, she listed the Rule of Law Society and Rule of Law Foundation, which are New York-based nonprofit groups founded by exiled Chinese billionaire Guo Wengui, a close associate of Bannon, who in 2018 was announced as chairman of the Rule of Law Society. When Bannon was arrested on fraud charges in August, he was aboard Guo’s 150-foot yacht, off the coast of Connecticut. (President Donald Trump last month pardoned Bannon, his former campaign chairman and White House chief strategist).

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Yan said she listed the Rule of Law entities out of respect for what she said was their work helping dissidents in China, and that they paid for her flight from Hong Kong and provided a resettlement stipend while she largely lives off her savings. She said her work is independent, and she rejected notions that Bannon was helping her spread political claims.

“I didn’t know he was so controversial when I was in Hong Kong,” Yan told The Post.

On Sept. 15, the day after Yan’s paper appeared on Zenodo, she was a guest on Fox’s “Tucker Carlson Tonight,” an appearance watched by 4.8 million broadcast viewers and 2.8 million on YouTube, and that also generated extensive engagement on Facebook and Twitter, according to the Harvard researchers. Bannon appeared on Carlson’s show that same week and discussed Yan’s claims. He also interviewed her on “War Room: Pandemic” 22 times last year, both before and after the Zenodo publication.

The political context was obvious in the midst of a hotly contested election in which Trump was attacking Democratic rival Joe Biden for supposedly being overly sympathetic to the Chinese government, dubbing him “Beijing Joe.” Republicans, including White House trade adviser Peter Navarro, pushed Yan’s paper along with the hashtag #CCPLiedPeopleDied, a reference to the Chinese Communist Party.

Archives showed the paper had more than 150,000 views on its first day on Zenodo — spectacular reach for a scientific paper, especially one that had not yet been reviewed by any independent experts.

But this surge of attention also generated backlash, including critical news reports by National Geographic and others, raising serious questions about Yan’s claims.

In the academic world, the Center for Health Security at Johns Hopkins issued a point-by-point response one week after Yan’s paper appeared on Zenodo, raising 39 individual issues in what it said was “objective analysis of details included in the report, as would be customary in a peer-review process.”

A few days later, the MIT Press online journal “Rapid Reviews: COVID-19” featured four scathing reviews, including one from Robert Gallo, a renowned AIDS researcher and a titan within the field of virology.

He labeled Yan’s work “misleading” and cited “questionable, spurious, and fraudulent claims.” Most points were highly technical, but Gallo also questioned her logic regarding the alleged role in creating the coronavirus for the Chinese military, which Gallo noted would be vulnerable to covid-19.

“And how would the Chinese protect themselves?” Gallo asked in his review. “Well, according to the paper, the military knew it could be stopped by remdesivir,” a drug later shown to have some benefit in treating covid-19 while not necessarily reducing the risk of death. “I would surely not want to be in the Chinese military if they were that naive.”

The idea to recruit Gallo came from Bertozzi, the journal’s editor and dean emeritus of the School of Public Health at University of California at Berkeley. Like Gallo, Bertozzi had worked extensively in AIDS research. After seeing Yan’s appearance on Fox, he was eager to use the online journal founded only months earlier to correct the scientific record.

“I felt it needed to be quickly debunked by people with scientific credibility,” Bertozzi said.

He soon thought of Gallo.

“We need somebody of your stature to say this is garbage science,” Bertozzi recalled telling him.

The reviews by Gallo and three other scientists also came with an editor’s note raising questions about the preprint process itself, saying, “While pre-print servers offer a mechanism to disseminate world-changing scientific research at unprecedented speed, they are also a forum through which misleading information can instantaneously undermine the international scientific community’s credibility, destabilize diplomatic relationships, and compromise global safety.”

But these public rebukes from some of the biggest names in virology did not deter Yan. Nor did a detailed report on Oct. 21 by CNN quoting her critics and documenting flaws.

Yan declined to be interviewed for that story, she said, because CNN did not allow her to address the issues they unearthed, point by point, on live television.

Instead, she published her own response on Nov. 21, on Zenodo, titled, “CNN Used Lies and Misinformation to Muddle the Water on the Origin of SARS-CoV-2.”

In her Post interview, Yan acknowledged — as CNN had reported — that her three co-authors on the original Sept. 14 paper were pseudonyms, used to protect what she said were other Chinese researchers whose families remain in peril back in China. Authors are typically discouraged from using false names in academic work.

Her claims suffered another blow this week, when a World Health Organization team sent to China to investigate the origins of the pandemic issued a statement saying it was “extremely unlikely” that the coronavirus came from a lab.

One of Yan’s earliest vocal critics, virologist Angela Rasmussen, who was at Columbia when Yan’s paper first spread, agreed with WHO’s assessment but did not rule out the possibility — however unlikely — of laboratory origin for the coronavirus. But she said the argument lacks concrete evidence.

“There needs to be a lot less speculation and a lot more investigation,” said Rasmussen, now an affiliate at Georgetown’s Center for Global Health Science and Security. “It takes a really long time to figure this stuff out... This is going to take years or even decades to solve it, if we ever do.”

Yet Yan continues to double down on her claims and to attack her critics as spreading “lies.” She still argues that the Chinese government intentionally created the coronavirus and continues to do everything it can to silence her.

Yan also offers no apologies for making common cause with Bannon and other Trump allies. As a dissident, she said, she doesn’t necessarily get her choice of supporters.

“If China is going to do this crime, who can hold them accountable?… Trump was the one who was tough” against China, Yan said, adding that her claim “is about real fact. I don’t want to mislead people.”

Even now, she is preparing another paper, nearing 30 pages, that she hopes will refute her critics and bring fresh attention to her claims about China, covid-19 and what she says is an international coverup campaign.

Yan plans to publish it in a few weeks, she said — on Zenodo.

#china covid19 covid-19

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