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Favipiravir is an anti-viral agent that inhibits RNA-dependent RNA polymerase of several RNA viruses and is approved for the treatment of influenza in Japan. It has a role as an antiviral drug, an anti-coronaviral (COVID-19) agent but the poor solubility of the favipiravir in the aqueous media of the human body cause a reduction in the effectiveness and bioavailability. In the current work, the favipiravir was formulated for the first time as solid dispersed system with curcumin to improve dissolution property and antiviral activity during treatment of Covid-19. Binary and ternary mix of favipiravir and curcumin with/without soluplus were prepared and characterized by Differential Scanning Calorimetry (DSC), Powder X-ray Diffractometry (PXRD) and Fourier Transform Infrared Spec-troscopy (FTIR) and subjected to the dissolution test by apparatus I according to the European Pharma-copeia. The antiviral activity was measured by its cytotoxicity against A549-hACE2 cells. The results re-vealed that there was a reduction in the crystallinity of both binary and ternary mixtures with an en-hancement of the dissolution in comparison with the pure drug which accompanied by an improvement in the antiviral activity which is promising results that need further .Copyright © 2023, Colegio de Farmaceuticos de la Provincia de Buenos Aires. All rights reserved.
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INTRODUCTION: Patients supported on extracorporeal membrane oxygenation (ECMO) due to COVID-19 are at an increased risk of both thromboembolic complications and thrombocytopenia. Bivalirudin, a direct thrombin inhibitor, is increasingly being utilized for anticoagulation in the ECMO patient though there is largely a lack of literature within the COVID-19 population. The objective of our study was to evaluate the safety and efficacy of alternative anticoagulation with bivalirudin in patients on ECMO with COVID-19 respiratory failure. METHOD(S): This was a non-interventional retrospective chart review conducted at a single center large community hospital between January 2020 - November 2021. We included both venovenous (VV) and venoarterial (VA) adult ECMO patients anticoagulated with bivalirudin that tested positive for COVID-19. Patients were excluded if their duration of ECMO cannulation was less than 48 hours. Descriptive statistical analyses were performed utilizing median with interquartile range and frequency with percent as appropriate. RESULT(S): Overall, 180 ECMO patients were included in the study. The duration of ECMO cannulation was 29 (9-54) days and our cohort experienced a 42% mortality rate. The rate of thrombotic events including in-circuit thrombosis, arterial and venous thrombotic events was 22%. The median initial platelet count on ECMO was 206 (157-274) and the median nadir was 85 (48-121). ELSO defined major bleeding occurred at a rate of 53% within this cohort. CONCLUSION(S): To our knowledge, this study describes the largest number of patients anticoagulated with bivalirudin for ECMO secondary to COVID-19. Our results suggest similar rates of thrombotic events compared to ELSO registry data. While the half-life of bivalirudin is short, clinicians should still be cautious of bleeding due to lack of a specific reversal agent. Retrospective studies with a comparator cohort, as well as randomized trials are warranted to further evaluate the selection of intravenous anticoagulants in the ECMO population with and without COVID-19.
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Purpose: Undergoing radiotherapy treatment for breast cancer can be a daunting and anxiety-provoking experience. Evidence shows that empowering patients with education prior to commencing treatment can have a positive impact on their anxiety levels [1,2]. We aimed to educate this patient cohort through the development of a video to reinforce information delivered at consultation regarding the treatment process and side-effects of breast radiotherapy. Methods: We created a patient information video in collaboration with breast cancer patients, which is available to view on the Royal Free Hospital Trust website via the following link:. Audits were carried out to assess patient satisfaction and anxiety levels in breast cancer patients receiving radiotherapy before and after implementation of the video. Results: Pre-video implementation data (n = 25): 36% (9/25) of patients reported feeling anxious about starting radiotherapy, 28% had neutral feelings and 36% had no anxiety. 68% (17/25) of patients felt they would benefit from an educational video. Post-video implementation data (n = 29): 72% of patients (21/29) watched the video, 95% of patients (20/21) would recommend the video to other patients, 85% found it helped prepare them for what to expect from radiotherapy, 33% (7/21) felt the video reduced their anxiety levels. Data collected post-onset of the COVID-19 pandemic in UK (n = 15): 66% of patients felt COVID-19 has negatively impacted their cancer treatment. The proportion of patients who watched the video increased from 58% to 80% pre- and post-onset of the COVID-19 pandemic. Conclusion: Our video has been viewed 18 354 times at the time of writing, showing very encouraging patient engagement. It is an effective method of preparing a vulnerable population for radiotherapy from the safety of their own home during the COVID-19 pandemic. Although only 33% felt it improved their anxiety levels, only 36% of patients had anxiety regarding treatment at any point. References [1] Nabavi FH, Behboudifar A, Pouresmail Z, Shafiee MN. Effect of pre-treatment education programs on the anxiety of patients receiving radiotherapy: an integrative literature review. Evidence Based Care J 2016;6:49–62. [2] Assessing the impact of educational video on student engagement, critical thinking and learning: the current state of play ;Education.report. Available at:.
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Background/Aims In 2000, a survey of medical educators was published exploring undergraduate rheumatology training across medical schools in the UK. This has recently been repeated. However, neither have surveyed the opinions of the medical students themselves - arguably the most important stakeholders. To evaluate how students perceive their rheumatology training, understand how they best learn and to explore how they engage with rheumatology on clinical placements, especially in the context of the COVID-19 pandemic. Methods An online survey was emailed to students from medical schools across the UK. 'Snowball sampling' was used, where individual social contacts were used to create a network of medical students from each of the 37 medical schools across the UK through social media such as SMS, WhatsApp, Facebook messenger, and Instagram. Students were asked similar questions as those in the teacher survey;however, emphasis was placed on their perspective of teaching methods and their clinical placements. Results 30 completed surveys were returned (81%) but not all questions were answered. Of those, 27/28 (97%) identified some sort of MSK teaching, in contrast to only 16/28 (57%) being able to identify specific rheumatology teaching. This was delivered in diverse ways;42% (10/ 24) learnt it in a block, while 38% (9/24) had this teaching spread out over a longer period of time. Teaching was quite varied amongst the schools. On average 9 days were spent learning rheumatology. The most commonly used methods were lectures, small-group teaching, and online tutorials. This contrasts with what students felt was most effective, which were small-group sessions, expert patient teaching and teaching OSCE's. It was noted that medical education and placements had been very different over the previous 18 months with a 41% decrease in patient contact during COVID-19 pandemic. Most students found rheumatology as a difficult field to approach. 66% (14/ 21) were not aware of any specific rheumatology SSCs or personal excellence pathways. 86% (19/22) stated there was limited-to-no promotion of rheumatology as a specialty in their medical school, and 87% (26/30) weren't aware of VA, ARUK, or BSR resources to assist in their rheumatology education. Conclusion This is the first survey to evaluate the views of medical undergraduates on their rheumatology teaching in the UK. It is intended that this data will be triangulated with the medical teacher survey. The findings highlight that what students would prefer in terms of teaching i.e. face to face teaching with patients, is not what is currently being delivered (mainly lectures, on-line tutorials). Of some concern there appeared to be a general lack awareness of available online resources, especially from VA and BSR, suggesting marketing of these may not be effective.
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OBJECTIVE: The aim: To find an association of COVID-19 on different types of leukocytes either count increasing or decreasing. PATIENTS AND METHODS: Materials and methods: A cross sectional study conducted from October /2020 to January /2021. Eighty patients out of 170 were enrolled in this study, who were attended a private clinic for clinical investigation and a private laboratory for laboratory diagnosis of COVID-19 who were divided into two groups, asymptomatic or mild (group 1), and moderate or severe (group 2). Five milliliter of blood samples were collected from patients with COVD-19 by venipuncture using a syringe for evaluation of different cells. RESULTS: Results: The current study revealed a significant difference in white blood cells count, neutrophils count, monocytes count, basophils count, and neutrophil to lymphocyte ratio, lymphocyte to monocyte ratio between group 1 and group 2. While lymphocytes, and eosinophil showed no significant difference. CONCLUSION: Conclusion: The current study concluded that COVID-19 may affect the count of some leukocytes in patient with severe infection.
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Background: One of the major challenges with COVID-19 has been the changes to cancer services, including changes to the type of systemic anti-cancer treatment being delivered to patients. There needs to be a better understanding of which cancer patients are at the greatest amount of risk to make informed decisions on how cancer treatment can be altered to protect patients from COVID-19 infection. The CAPITOL (COVID-19 CAncer PatIenT Outcomes in North London) study investigated the outcomes of patients receiving systemic anti-cancer therapies (SACT) with regards to COVID-19 infection, as patients with cancer are hypothesised to be at higher risk. Methods: CAPITOL collected data from all patients receiving SACT at two cancer centres. The effect of clinical characteristics on the incidence and severity of COVID-19 infection in patients on SACT was the primary outcome, and we used univariable and multivariable models in our analysis, adjusting for age, gender and comorbidities. Results: 2871 patients were analysed from 2nd March to 31st May 2020, all of whom received SACT;during this time period 68 (2.4%) were diagnosed with COVID-19. Receiving SACT increased the risk of death when contracting COVID-19 (adjusted (adj.) OR 9.84;95% CI 5.73 - 16.9). The risk of contracting COVID-19 was increased by receiving chemotherapy (adj. OR 2.99;95% CI = 1.72 - 5.21), with the risk significantly increased by high dose chemotherapy (adj. OR 2.36, 95% CI 1.35 - 6.48). Patients with comorbidities (adjusted OR 2.29;95% CI 1.19 - 4.38), or with a respiratory or intrathoracic neoplasm (adj. OR 2.12;95% CI 1.04 - 4.36) were also at increased risk of contracting COVID-19. Cancer patients who received targeted treatment had a reduced risk of contracting COVID-19 (adj. OR 0.53;95% CI 0.30 - 0.95), while there was no significant change in risk caused by treatment intent (curative versus palliative), hormonal- or immunotherapy and solid versus haematological cancers. Conclusions: To the best of our knowledge, this is one of the first investigations into the risk of contracting COVID-19 in a cohort of all cancer patients on SACT. We found that patients on SACT are more likely to die if they contract COVID-19. The type of SACT received by cancer patients can affect their likelihood of contacting COVID-19, with chemotherapy increasing risk, targeted therapy decreasing risk and a potential protective effect for hormonal and immunotherapy.
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Objective: Due to the COVID 19 pandemic, the paediatric complex epilepsy service changed rapidly from face to face clinics to virtual clinics. The Evelina London Complex epilepsy team was involved in the RCPCH EQIP collaborative pilot, our project was adapted to investigate patient experience and satisfaction for Virtual consultation. Methods: We designed a questionnaire consisting of 19 questions. 15 were multiple choice questions and three were qualitative. Patients were selected randomly from virtual clinic booking lists from March to July 2020. The questionnaires were completed using telephone interview with parents. Results: We obtained feedback from 20 families. Response rate was 100%. 17/20 (85%) of the responders rated the quality of virtual consultations compared with face to face as good (n=11) and excellent (n=6). Similarly, 17/20 (85%) were very satisfied (n=10) or satisfied (n=7) with virtual consultations. 14/20 (70%) responders felt it respected confidentiality. However 5/20 (25%) responders reported technical issues during the consultation. Given a choice on ongoing epilepsy consultations, 8/20 responders preferred to continue virtual consultations, 6/20 would prefer face to face appointments, 5/20 chose both virtual and face to face depending on the circumstances and 1/20 preferred a phone clinic. Qualitative feedback included "With face to face clinics my child gets a personal connection with the Consultant who can also examine her" Others supported virtual appointments "If routine check-up or discussion of seizure diary and management then virtual is easier" Responders gave suggestions for how their virtual experience can be improved. Conclusion: Virtual clinic consultations are usually acceptable to parents. Our survey demonstrates that the majority of families would also like to have a continued option for a face to face clinic and it highlighted improvements that can be made with virtual consultations. Continued survey of parent/carers and patients throughout the pandemic and beyond will aid to inform organisation of outpatient epilepsy services.
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Background: People living with HIV (PLWH) have an increased burden of kidney disease and unique factors that may place them at increased risk for acute kidney injury (AKI) in the setting of COVID-19. The aim of our study was to characterize the incidence, risk factors and outcomes of AKI among hospitalized PLWH with COVID-19. Methods: We performed a retrospective study of adult PLWH hospitalized with laboratory-confirmed COVID-19 in a large healthcare system in Bronx, New York from March 10-May 11, 2020. Data collected included demographics, comorbidities, antiretroviral therapy (ART), initial laboratory data, and preadmission CD4 count and HIV viral load. AKI was defined and staged using KDIGO criteria. Fisher and Wilcoxon tests compared differences in those with and without AKI. Results: During the study period, 77 PLWH were hospitalized with COVID-19. The majority were Black or Hispanic, 50% were men, 53% had hypertension, 31% diabetes mellitus, 22% chronic kidney disease (CKD) and 14% end-stage kidney disease (ESKD). Mean CD4 count was 470 cells/uL and 83% had a suppressed HIV viral load (<40 copies/ mL). After excluding 11 with ESKD, AKI incidence was 50%. Those with AKI were older [63 (SD 9) vs 55 (SD 13) years, p=0.005], more were black (56% vs 37%, p=0.01) and more had CKD (42% vs 9%, p<0.0001) compared to those without AKI. There were no significant differences in CD4 count, HIV viral load, or use of tenofovir-containing ART between those with and without AKI. By AKI severity, 11/33 (33%) were stage 1, 4/33 (12%) stage 2 and 18/33 (55%) stage 3. Mechanical ventilation (33% vs 0%, p=0.0004) and in-hospital mortality (42% vs 3%, p=0.0002) were more common in those with AKI. Of 6 patients who required renal replacement therapy, 4 died and 2 remained RRT dependent. Admission white blood cell count, neutrophil/lymphocyte ratio, D-dimer, ferritin, C-reactive protein and lactate dehydrogenase levels were significantly higher in those with AKI. Conclusions: The incidence of AKI in PLWH hospitalized with COVID-19 was high and associated with poor outcomes. We did not identify HIV-specific risk factors for AKI in the setting of COVID-19. Admission inflammatory markers may be predictive of AKI in PLWH with COVID-19.