Individualizing methadone treatment with split dosing: An underutilized tool.

Methadone's long half-life typically allows for once daily dosing. However, a growing body of evidence and clinical experience shows that some patients may benefit from twice-daily ("split") dosing to produce more stable symptoms and minimize side effects, independent of serum peak-to-trough levels. Concerns regarding split dosing typically center on diversion and poor adherence and must be taken seriously. However, policy changes during COVID-19 demonstrate that the rigidity historically applied to methadone may be unnecessarily stringent. Given clinical advances and policy updates, we believe clinicians should weigh the risks and benefits of this underutilized tool for select patients, as we await the evidence-based recommendations our patients deserve.

Prevalence of abnormalities on cardiac MRI in unselected patients after recovery from acute SARS-CoV-2 infection and correlation with markers of immunity and coagulation: The SETANTA study

Background: Previous studies have reported ongoing cardiac inflammation as assessed by cardiac magnetic resonance imaging (CMR) in a significant proportion of patients several months after recovery from SARSCoV- 2 infection, many of whom had no or minimal symptoms at the time of infection. Purpose(s): The aim of SETANTA was to investigate the prevalence of cardiac abnormalities by CMR in unselected patients in Ireland after acute SARS-CoV-2 infection and the correlation with immunological response and biomarkers of coagulation. Method(s): This was a prospective, observational, community-based study (clinicaltrials.gov identifier NCT04823182). Consecutive patients recovered from recent SARS-CoV-2 infection at 3 primary care sites were invited to participate. Key inclusion/exclusion criteria and outcomes of interest are shown in Figure 1. Result(s): 100 participants were enrolled (Feb-Sept 2021) at a median of 188 (IQR, 125, 246) days after positive SARS-CoV-2 swab. At index infection, 18% and 35% reported severe and moderate symptoms, respectively;14% were hospitalized;3% were admitted to intensive care for ventilatory support. At enrolment, 83% had ongoing symptoms. 85% had detectable SARS-CoV-2 antigens. CMR and laboratory findings are shown in Figure 1. Conclusion(s): Among an unselected cohort of patients recovered from acute SARS-CoV2 infection, we report a low prevalence of cardiac abnormalities by CMR, despite a high prevalence of moderate/severe symptoms at presentation and a high prevalence of persistent symptoms. Correlation with biomarkers of immunity and coagulation will be available at ESC 2022.

A Smart and Home-based Telerehabilitation Tool for Patients with Neuromuscular Disorder

Over fourteen million people suffer from neuromuscular diseases in the UK such as strokes, spinal cord injuries, and Parkinson's disease etc. That means at least one in six people in the UK are living with one or more neurological conditions. In order for patients to return to normal life sooner, a rigorous rehabilitation process is needed. In hospitals, physiotherapists and neurological experts prescribe specific neurorehabilitation exercises. In most cases, patients need to schedule an appointment to receive treatment in a hospital or to have physiotherapists visit them at home. The number of neuromuscular patients has increased, resulting in longer hospital waiting times. In particular, during COVID-19, patients were not allowed to visit hospitals or have physiotherapists visit them due to government restrictions. Online guides for personalised and custom rehabilitation therapy for joint spasticity and stiffness are also not available. This paper reports the development of an IoT-based prototype system that monitors and records joint movements using sensory footwear (consisting of FSR and IMU sensors) and Kinect sensors. In addition, a prototype web portal is also being developed to record performance data during exercises at home and interact with clinicians remotely. A pilot study has been conducted with six healthy individuals and test results show that there is a strong correlation between Kinect data and FSR data in terms of coordination between joint movements. © 2022 IEEE.

Sotrovimab in Heart Transplant Recipients with Covid-19 in the Omicron Era: A National Transplant Center Experience

Early use of anti-SARS-CoV-2 monoclonal antibodies has shown to be a safe option to reduce hospitalization and death in solid organ transplant recipients with COVID-19. Real world data regarding sotrovimab in heart transplant (HT) recipients is scarce. We aim to describe our experience in terms of safety and outcomes in this group. Consecutive HT recipients from our center with confirmed SARS-CoV-2 Omicron variant who received intravenous sotrovimab infusion between January and April 2022 were enrolled in this observational study. Clinical data was recorded including the first 24 hours post infusion, as well as 1-month and 3-month follow-ups. A total of 29 HT recipients with SARS-CoV-2 infection who received sotrovimab were enrolled [median age 53 (IQR 36, 62), 52% female]. Baseline characteristics are shown in Table 1. The median time since symptom onset was 2 (1,3) days, and 86% of patients had previously received ≥3 doses of COVID-19 vaccine. No acute infusion-related reactions were reported. A total of five patients were admitted (17%), 3 of them with COVID-19 pneumonitis, receiving high-dose steroids. Bacterial superinfection was reported in 4 patients. Neither invasive mechanical ventilation nor ICU care were required, and no in-hospital deaths were recorded. Hospitalized patients had more comorbidities [diabetes (40 vs 13%, p 0.13), hyperlipidemia (80 vs 29%, p 0.03), advanced chronic kidney disease (100 vs 38%, p 0.01), leucopenia (40 vs 4%, p 0.02), and anemia (100 vs 46%, 0.03)], compared to non-hospitalized patients. Over a median follow-up of 111 (86, 131) days, there were 2 cases of COVID-19 reinfection and 6 non-COVID-19-related readmissions. No episodes of acute rejection, new onset graft dysfunction or death were registered. In our series, the early use of sotrovimab in HT recipients with COVID-19 was safe. No COVID-19-related deaths were recorded, hospitalization rate was low and more frequent in patients with prior chronic comorbidities. [ FROM AUTHOR] Copyright of Journal of Heart & Lung Transplantation is the property of Elsevier B.V. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full . (Copyright applies to all s.)

Lung transplant and COVID-19: A single centre experience in Ireland

As of April 2022, the Mater Hospital serves 190 patients who have been the recipient of a lung transplant in Ireland. During the COVID-19 pandemic, solid organ transplant was recognised as a risk factor for progression to severe disease. In January 2022, the European Medicines Agency (EMA) approved the use of Sotrovimab for high risk patients. Sotrovimab is a monoclonal antibody which neutralises SARS-CoV-2 with recent data showing efficacy in reducing the risk of progression to severe disease in high risk patients . We aim to describe our patient cohort and the rates of COVID-19 infection seen before and after the introduction of monoclonal antibody therapy. While likely reflecting emerging variants resulting in less severe disease, we observe variation in morbidity and mortality in this time. From March 2020 to April 2022, 116 post-lung transplant patients tested positive for COVID-19 infection. This represents 61% of our overall population. Since January 2022, coinciding with the surge of the omicron variant, 57 patients contracted COVID-19. 47 were deemed to be suitable for treatment with 10 presenting outside the window for therapeutic intervention. 3.5% (n=2) required ICU admission and 2 died directly as a result of COVID-19. Prior to this, 58 patients contracted COVID-19, 31 of which (53.5%) required hospital admission with 18 (58%) requiring ICU admission. Overall we saw 13 deaths representing 22.4% of this group and 6.8% of the overall population.

Impact Assessment of COVID-19 Severity on Environment, Economy and Society towards Affecting Sustainable Development Goals

The COVID-19 pandemic has affected every sector in the world, ranging from the education sector to the health sector, administration sector, economic sector and others in different ways. Multiple kinds of research have been performed by research centres, education institutions and research groups to determine the extent of how huge of a threat the COVID-19 pandemic poses to each sector. However, detailed analysis and assessment of its impact on every single target within the 17 Sustainable Development Goals (SDGs) have not been discussed so far. We report an assessment of the impact of COVID-19 effect towards achieving the United Nations SDGs. In assessing the pandemic effects, an expert elicitation model is used to show how the COVID-19 severity affects the positive and negative impact on the 169 targets of 17 SDGs under environment, society and economy groups. We found that the COVID-19 pandemic has a low positive impact in achieving only 34 (20.12%) targets across the available SDGs and a high negative impact of 54 targets (31.95%) in which the most affected group is the economy and society. The environmental group is affected less;rather it helps to achieve a few targets within this group. Our elicitation model indicates that the assessment process effectively measures the mapping of the COVID-19 pandemic impact on achieving the SDGs. This assessment identifies that the COVID-19 pandemic acts mostly as a threat in enabling the targets of the SDGs.

HIV Exposure Prophylaxis Delivery in a Low-barrier Substance Use Disorder Bridge Clinic during a Local HIV Outbreak at the Onset of the COVID-19 Pandemic.

OBJECTIVES: People who inject drugs (PWID) may experience high human immunodeficiency virus (HIV) risk and inadequate access to biomedical HIV prevention. Emerging data support integrating HIV post-exposure and pre-exposure prophylaxis (PEP, PrEP) into services already accessed by PWID. We describe PEP/PrEP eligibility and receipt in a low-barrier substance use disorder bridge clinic located in an area experiencing an HIV outbreak among PWID at the onset of the COVID-19 pandemic. METHODS: Retrospective chart review of new patients at a substance use disorder bridge clinic in Boston, MA (January 15, 2020-May 15, 2020) to determine rates of PEP/PrEP eligibility and prescribing. RESULTS: Among 204 unique HIV-negative patients, 85.7% were assessed for injection-related and 23.0% for sexual HIV risk behaviors. Overall, 55/204 (27.0%) met CDC criteria for HIV exposure prophylaxis, including 7/204 (3.4%) for PEP and 48/204 (23.5%) for PrEP. Four of 7 PEP-eligible patients were offered PEP and all 4 were prescribed PEP. Thirty-two of 48 PrEP eligible patients were offered PrEP, and 7/48 (14.6%) were prescribed PrEP. Additionally, 6 PWID were offered PrEP who lacked formal CDC criteria. CONCLUSIONS: Bridge clinics patients have high rates of PEP/PrEP eligibility. The majority of patients with identified eligibility were offered PEP/PrEP, suggesting that upstream interventions that increase HIV risk assessment may support programs in initiating PEP/PrEP care. Additional work is needed to understand why patients declined PEP/PrEP. PrEP offers to PWID who did not meet CDC criteria also suggested provider concern regarding the sensitivity of CDC criteria among PWID. Overall, bridge clinics offer a potential opportunity to increase biomedical HIV prevention service delivery.

Prevalence and Characteristics of Abnormalities on Cardiac Mri in Unselected Patients after Recovery from Acute Sars-Cov-2 Infection and Correlation with Markers of Immunity and Coagulation: The Study of Heart Disease and Immunity after Covid-19 in Ireland (Setanta)

Introduction Previous studies have reported ongoing cardiac inflammation as assessed by cardiac magnetic resonance imaging (CMR) in a significant proportion of patients several months after recovery from SARS-CoV-2 infection, many of whom had no or minimal symptoms at the time of infection. The aim of SETANTA was to investigate the prevalence of cardiac abnormalities by CMR in unselected patients in Ireland after acute SARS-CoV-2 infection and the correlation with immunological response and biomarkers of coagulation. Methods This was a prospective, observational, communitybased study (clinicaltrials.gov identifier NCT04823182). Consecutive patients recovered from recent SARS-CoV-2 infection at 3 primary care sites were invited to participate. Key inclusion/ exclusion criteria and outcomes of interest are shown in figure 1. Results 100 participants were enrolled (Feb-Sept 2021) at a median of 188 (IQR, 125, 246) days after positive SARSCoV- 2 swab. At index infection, 18% and 35% reported severe and moderate symptoms, respectively;14% were hospitalized;3% were admitted to intensive care for ventilatory support. At enrolment, 83% had ongoing symptoms. 85% had detectable SARS-CoV-2 antigens. CMR and laboratory findings are shown in Figure 1. Clinical follow up to 12 months is ongoing. Conclusion Among an unselected cohort of patients recovered from acute SARS-CoV2 infection, we report a low prevalence of cardiac abnormalities by CMR, despite a high prevalence of moderate/severe symptoms at presentation and a high prevalence of persistent symptoms. Correlation with biomarkers of immunity and coagulation add results of follow up at 12 months will be available for presentation at ICS 2022.

Humoral response to SARS-CoV-2 vaccination among heart transplant recipients aged 18–70 years of age administered two doses of an adenoviral vector (ChAdOx1 nCoV-19) vaccine and a messenger RNA (BNT162b2) booster

28 Figure 1a) Frequency of a detectable antibody response after each vaccination for 80 heart transplant recipients, b) Interval change in anti-spike antibody titres between the 2nd ChAdOx1 nCoV-19 vaccine and the 3rd dose mRNA (BNT162b2) booster vaccine.[Figure omitted. See PDF]Conclusions/ImplicationsHeart transplant recipients who received 2 doses of the ChAdOx1 nCoV-19 viral vector vaccine and a mRNA booster vaccine failed to develop a detectable antibody response in 44% of cases. These findings highlight the importance of maintaining protective measures for transplant recipients, particularly those on more intensive immunosuppressive regimens, both at a personal and public health level, as well as investigating additional strategies to protect this vulnerable patient cohort.

Undergraduate Medical Education during Coronavirus Disease 19: Scope, Practices and Limitations in Developing Countries

Purpose: Coronavirus Disease 19 has highly impacted the education system and created the trend of online classes. To fill in the gap created by lock down and to continue an uninterrupted learning process, educational institutions worldwide started organizing online classes. Although Medical education is mostly practice based but it was not safe to conduct on campus classes. This study aimed at measuring the scope and limitations of online education and the overall impacts of Coronavirus Disease 19 on the medical education system. Methodology: Cross-sectional study. Ethical approval was obtained from Ethical committee South Point Hospital. Informed consent was obtained. Self-administered questionnaires were given to the participants. Results: E-Learning opportunities were made available in 98.69% cases;some student forums also participated creating additional opportunities. Out of 260 students, 108 (41.1%) were males and 152 (57.8%) females. 29.3% belonged to Metropolitan Area, 28.9% to District Town, 16.3% to Upazila Town, 24.3% to village and 0.4% to unspecified areas. The quality of internet was reported as excellent, good, fair and poor. Only 1.9% of the students had more than 80% attendance. Zoom was used in 57.8% situations followed by Facebook live (15%) and was least for pre-recorded video upload, YouTube link etc. On investigation about quality of lectures, 8.7% people rated excellent while 75.7% students marked them fair to good and 14.8% rated as poor. 46.8% of students showed satisfaction towards online assessments and 44.5% students were not satisfied. Families of 57.4% respondents faced financial stress. 6.8% faced none whereas 29.3% students faced huge mental stress during Coronavirus Disease 19. Conclusions: E-learning is the new normal during Coronavirus Disease 19 pandemic. Given the opportunity, medical students although benefited a lot but there existed a technological divide. There were also financial and mental stresses to certain extent.

Towards an Improved Substance Use Disorder Treatment Landscape in Rhode Island – Barriers, Current Progress, and Next Steps

Expanding addiction treatment services in Rhode Island has never been more urgent. Today, we face colliding syndemics of COVID-19, preventable drug overdoses, and HIV, with another year of record overdoses. While the treatment of substance use disorder (SUD) is an sential of general medical care, numerous barriers prevent broader treatment access for patients in Rhode Island. Buprenorphine and methadone therapy have restrictions that are not applied to other areas in medicine, including for more dangerous medications. In this piece, we highlight existing barriers to care, applaud current progress being made in our state, and provide recommendations for next steps to turn the tide of this deadly epidemic. We hope that these proposed changes will help develop a robust treatment landscape for all patients with SUD in Rhode Island.

Change from transrectal to transperineal ultrasound-guided prostate biopsy under local anaesthetic eliminates sepsis as a complication.

Transrectal ultrasound-guided (TRUS) biopsy of the prostate is associated with increased risk of post-procedural sepsis with associated morbidity, mortality, re-admission to hospital, and increased healthcare costs. In the study institution, active surveillance of post-procedural infection complications is performed by clinical nurse specialists for prostate cancer under the guidance of the infection prevention and control team. To protect hospital services for acute medical admissions related to the coronavirus disease 2019 (COVID-19) pandemic, TRUS biopsy services were reduced nationally, with exceptions only for those patients at high risk of prostate cancer. In the study institution, this change prompted a complete move to transperineal (TP) prostate biopsy performed in outpatients under local anaesthetic. TP biopsies eliminated the risk of post-procedural sepsis and, consequently, sepsis-related admission while maintaining a service for prostate cancer diagnosis during the COVID-19 pandemic.

Multidisciplinary approaches to coping with neurodegenerative disorders amid COVID-19 pandemic

Neurodegenerative disorders, including Alzheimer’s and Parkinson’s, are the leading causes of dementia in the elderly. In the coming days, an alarming upsurge of dementia patients is expected with increasing life expectancy. This is the scenario not only in the developed world but also in the developing world, where older people live in vulnerable situations. Even in the COVID-19 (coronavirus disease-19) pandemic, the situation has worsened. Due to the limitations of conventional therapeutic strategies, it is necessary to explore integrated approaches consisting of both pharmacological and non-pharmaceutical interventions. As existing anti-dementia drugs pose many adverse effects on patients, pharmacological intervention through naturally occurring agents should be employed to explore targeted therapy. Alongside, non-pharmacological interventions such as cognitive and motor rehabilitation, occupational therapy, and psychological therapy need to be explored. From this perspective, multidisciplinary approaches need to be employed in order to develop a sustainable patient-friendly treatment strategy for the management of these emerging health issues with tremendous social burdens. © 2022, Bangladesh Society for Microbiology, Immunology and Advanced Biotechnology. All rights reserved.

Treatment adherence support and relationships with CKD providers: A qualitative analysis

Background: Adherence is critical in chronic kidney disease (CKD) to delay progression to kidney failure. Treatment plans for CKD can include medications, diet, and exercise. Overall adherence to treatment is low in CKD, and also as few as 40% of new kidney failure patients have any documented CKD-related care. The purpose of this study was to explore CKD patients' experiences of adherence to treatment plans and what role their healthcare providers had in supporting adherence. Methods: As part of a larger mixed-methods study of Chronic Renal Insufficiency Cohort (CRIC) study participants, a subset was randomly selected for 1:1 interviews. All CRIC participants are >45 years with CKD stages 1-4, and this sample consisted of University of Pennsylvania participants interviewed in 2019-2020. Participants described their experiences with adherence and what they have done when experiencing difficulty. Interviews were recorded, transcribed, and coded using conventional content analysis. Results: The sample (n=32) had a mean age of 67 years, 53% women, 59% nonwhite. After analysis of factors relevant to treatment planning and adherence, four themes emerged: patient factors (multiple chronic conditions, motivation, outlook), provider factors (attentiveness, availability, communication), treatment planning factors (lack of plan, proactive patient research, provider-focused goals, and shared decision making), and patient responses to the treatment plan (disagreeing with treatment, frustration with their lack of adherence [I know what to do], lack of information, and positive feedback). Patients also described the impact of COVID on access to care and the positive impact of family, ancillary providers, and routines/habits. Conclusions: These themes align with behavioral learning theory, which includes: internal antecedents (patient factors), external antecedents (provider factors), behavior (treatment planning and attempts at adherence), and consequences (adherence and responses to the treatment plan). Our results provide many potential points of intervention to support treatment adherence in CKD, and a tailored approach is needed to address patients' specific adherence factors.

Prevalence and characteristics of abnormalities on cardiac MRI in primary care following recovery from acute SARS-CoV-2 infection and correlation with markers of immunity and coagulation: primary results of the setanta study

32 Figure 1ConclusionThe SETANTA study will evaluate the prevalence and characteristics of abnormalities on cardiac MRI in primary care patients in Ireland following recovery from acute SARS-CoV-2 infection and assess correlation with immune response and coagulopathy. Data from the study will help inform the long-term management of patients recovered from SARS-CoV-2 and assist in planning of health care service provision.

Pulmonary hypertension following severe COVID-19: a case report

Persistence of symptoms or development of new symptoms, late in the course of COVID-19 puts a constant burden on our healthcare facilities. In its severe form, COVID-19 patient may present as acute respiratory distress syndrome (ARDS), shock, and multiorgan failure and other immunological disharmony. With extensive parenchymal and vascular endothelial damage to lung vasculature, some patient may develop extensive fibrosis and pulmonary hypertension. Our patient a 60-year-old male, slightly overweight (BMI = 28.3) with history of IGT suddenly developed fever, sore throat and anosmia with myalgia. At 7th day of symptom his saturation fell down and patient was admitted in Bangabandhu Sheikh Mujib Medical University (BSMMU) for advance management. Initially patient was treated in COVID-19 ward, latter he was shifted to ICU as oxygen saturation was not maintained by HFNC. After a long battle of 56 days in ICU and 19 days stay in post COVID ward patient was discharged home with intermittent oxygen therapy only to develop pulmonary hypertension as a sequelae of post COVID syndrome. A holistic approach to management of post COVID syndrome is needed for such multisystem involvement of severe COVID patients.