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Background: Significant adjustments to maternity care in response to the COVID-19 pandemic and the direct impacts of COVID-19 can compromise the quality of maternal and newborn care., Aim: To explore how the COVID-19 pandemic negatively affected frontline health workers' ability to provide respectful maternity care globally., Methods: We conducted a global online survey of health workers to assess the provision of maternal and newborn healthcare during the COVID-19 pandemic. We collected qualitative data between July and December 2020 among a subset of respondents and conducted a qualitative content analysis to explore open-ended responses., Findings: Health workers (n = 1127) from 71 countries participated; and 120 participants from 33 countries provided qualitative data. The COVID-19 pandemic negatively affected the provision of respectful maternity care in multiple ways. Six central themes were identified: less family involvement, reduced emotional and physical support for women, compromised standards of care, increased exposure to medically unjustified caesarean section, and staff overwhelmed by rapidly changing guidelines and enhanced infection prevention measures. Further, respectful care provided to women and newborns with suspected or confirmed COVID-19 infection was severely affected due to health workers' fear of getting infected and measures taken to minimise COVID-19 transmission., Discussion: Multidimensional and contextually-adapted actions are urgently needed to mitigate the impacts of the COVID-19 pandemic on the provision and continued promotion of respectful maternity care globally in the long-term., Conclusions: The measures taken during the COVID-19 pandemic had the capacity to disrupt the provision of respectful maternity care and therefore the quality of maternity care., (Copyright © 2021 The Author(s). Published by Elsevier Ltd.. All rights reserved.)

Three patients, each more than 60 years of age at initial presentation, had early stage lymphoid infiltrates (formerly called reactive lymphoid hyperplasia) of the choroid and contiguous extraocular tissues. There were multifocal, confluent, and nonconfluent creamy patches in the choroid. These lesions changed very little over periods of observation ranging from 1 to 4 years and failed to produce ophthalmoscopically visible disturbances of the retinal pigment epithelium (RPE). Fluorescein angiography demonstrated dye collection within the lesions without leakage into the subretinal or subpigment epithelial spaces. Both ultrasonography and computed tomography (CT) showed thickening of the choroid with either anterior or posterior episcleral extensions of lymphoid tissue. Pathologic evaluation of biopsy specimens of extraocular portions of the lesions showed low-grade tumors that were diffuse infiltrates of mature lymphocytes, which exhibited lymphoplasmacytoid features, Dutcher bodies, or small residual germinal centers (so-called borderline lesions). Two patients had uniocular localized disease, whereas the third had bilateral ocular lesions, hypogammaglobulinemia, and another extranodal chest wall lymphoid tumor. Therapy for the localized ocular condition consisted either of oral administration of corticosteroids or low doses of radiotherapy.

To delineate the immunoarchitecture of the normal human lacrimal gland, monoclonal antibodies that detect B- and T-lymphocyte, macrophage, and dendritic cell lineage, subset, and differentiation-associated antigens were used in combination with highly sensitive tissue-section immunoperoxidase techniques. Plasma cells, identified with monoclonal antibody OKT10, represented the predominant mononuclear cell population, accounting for 53.9% of all mononuclear cells present. A qualitative study of plasma cell cytoplasmic immunoglobulin heavy-chain expression in deparaffinized, formalin-fixed tissue sections showed that the vast majority of these plasma cells contained IgA. Rare plasma cells contained IgG, IgM, or IgD. T-cells, identified with monoclonal antibody OKT3, represented the second most common cell type in the normal human lacrimal gland, accounting for 40.3% of all mononuclear cells present. T cells were located predominantly in lymphocytic foci and singly in the interstitium. T8 antigen-positive (suppressor/cytotoxic) T cells predominated over T4 antigen-positive (helper) T cells, averaging 25.2 and 14.7%, respectively. The overall mean T4/T8 ratio was 0.56. T8 antigen-positive T cells were the most numerous cell population outside aggregates and follicles, being distributed almost equally between the acini and the ducts (49%) and the interstitium (51%). Only 16% of T4 antigen-positive cells preferred glands or ducts to the interstitium. B cells, identified with monoclonal antibody BL9, represented only 5.7% of all mononuclear cells present. B cells were exclusively found in the centers of primary and secondary follicles. The majority of the surface immunoglobulin-positive B cells expressed IgM, fewer expressed IgD, and still fewer expressed IgG or IgA. Rare LeuM1+ OKM1+ macrophages were present in the center of B-cell follicles, where rare OKT6+ dendritic cells and activated T cells (IL-2+) were also discovered. These results support the concept that the lacrimal gland belongs to the mucosa-associated lymphoid system.

Monoclonal antibodies were used to analyze the lymphocytic subpopulations in frozen tissue sections of normal human conjunctiva (epibulbar, tarsal, and forniceal). The overwhelming majority of lymphocytes were T-cells (Leu1+ and OKT8+). In the epithelium, the predominant cell type was the OKT8+ cytotoxic/suppressor cell, whereas in the substantia propria, helper T-cells (Leu3a/3b+) equalled suppressor T-cells. T-cells outnumbered B-cells 20-fold; the letter cells were detected only in the substantial propria, particularly in the fornices, and not in the epithelium. Plasma cells, as identified by OKT10 staining, were completely absent except in the accessory lacrimal glands of Krause. Langerhans' cells, identified by OKT6 and HLA-DR (la) staining, were observed in the epithelium of all conjunctival regions. Our findings suggest that the reactivity of B-lymphocytes and plasma cells is heavily damped down by T-lymphocytes, thus allying the conjunctiva to other mucosal membranes and the skin as heavily immunoregulated tissues.

An 88-year-old man presented with 13 apocrine cystadenomas of both lower eyelids of at least 10 years' duration. The cysts were remarkable for possessing a superior dome of either creamy or yellowish material (probably reflecting the lipid-rich decapitation secretion), surmounting a clearer fluid inferiorly, as well as for being restricted to the eyelid margins where the glands of Moll are located. Light microscopy disclosed a double-layered cuboidal cellular lining, which focally became more plump or hobnailed, exhibited apical decapitation secretion, and was occasionally thrown into papillary folds. Electron microscopy demonstrated cellular debris and segments of interrupted plasmalemmas within the cystic cavity, intercellular widenings constituting canaliculi, cytoplasmic election-dense secretory granules, flocculent mucous vacuoles, and swirls of smooth-surfaced endoplasmic reticulum. Basal cells were focally interspersed between the secretory cells and the basement membrane, and occasionally manifested spotty myofilamentary differentiation. These findings are supportive of an origin of the lesions from the secretory rather than the ductal portion of the glands of Moll. They corroborate conclusions drawn from dermatologic investigations that the cysts are an essentially proliferative process as opposed to the result of passive ductal dilatation.

Langerhans cells belong to the dendritic cell family. Their presence in the conjunctiva and cornea has been demonstrated by means of various membrane and cytoplasmic markers. Utilizing OKT6, a monoclonal antibody that specifically binds to Langerhans cells in conjunction with la histocompatibility antigens (HLA-DR), and a new panel of monoclonal antibodies, we compared the population density and characteristic phenotypes of Langerhans cells in normal conjunctiva with those in normal epidermis. A greater density of Langerhans cells was noted in epidermis in comparison with conjunctiva. Various areas of the conjunctiva and cornea were mapped for Langerhans cell distribution. The T6/la ratio of Langerhans cells in conjunctiva was notably different from that in skin. Utilizing the Prolm2 marker, we identified non-Langerhans dendritic cells in the substantia propria and in the basilar epithelium of the conjunctiva, antigen-processing cells probably identical to the interdigitating dendritic cells of lymph nodes.

Over a 1-year period, a cystic bluish coloration developed in the most medial aspect at the margin of the right upper eyelid of a 40-year-old man. The clinical diagnoses were either a conjunctival inclusion cyst or an adnexal cyst, possibly of the gland of Moll. The excised specimen was studied histopathologically and exhibited a lining that was virtually indistinguishable from that of the normal canaliculus, except for hyperplasia of the cellular wall and the focal presence of a superficial mucin-producing columnar cell monolayer at the lumen. The medial edge of the excised specimen showed a merging of the cyst into a nonectatic portion of the canaliculus. Inflammation in the wall of the cyst and in this terminal portion of the canaliculus was not identified. This is believed to be a unique entity of an idiopathic ectasia with mild epithelial proliferation of a segment of the canaliculus. The authors have termed this condition canaliculops, to draw a parallel between it and ectasia of the ducts of the lacrimal gland, so-called dacryops.

Ocular cicatricial pemphigoid (OCP) is characterized by the deposition of immunoglobulin and complement along the conjunctival epithelial basement membrane zone (BMZ). In order to further elucidate the cellular populations of the local inflammatory infiltrates, the authors used a panel of monoclonal antibodies in cryostat tissue sections to delineate T cell subsets, B lymphocytes, dendritic cells, and macrophages in six patients with OCP. In comparison with matched controls of the epibulbar conjunctiva, the authors discovered a threefold increase in T lymphocytes within the epithelium and a 20-fold increase within the substantia propria. In contrast with the normal-standing population of conjunctival T lymphocytes, there were activated interleukin 2 receptor (IL-2R)-positive lymphocytes in both the epithelium and the substantia propria. Macrophages were the second most common cells in the substantia propria, accounting for 12.7% of the mononuclear population--a threefold increase over the normal percentage. B cells and plasma cells, normally absent from epibulbar conjunctiva, were the next most prominent populations, constituting 6.9 and 4.6%, respectively, of all mononuclear cells. Dendritic cells which process antigen locally constituted only 1.2% of the mononuclear cell population, but were increased 25-fold over normal controls. By elaborating cytokines that promote fibroplasia, the T cells in OCP may be effector cells along with macrophages and other inflammatory cells in bringing about scarification of the substantia propria, and may furthermore be responsible for an immunoregulatory defect that allows local B lymphocytes to produce autoantibodies to the BMZ.