ABSTRACT
Background In recent years, research has demonstrated the disparities in cardiovascular disease diagnosis and outcomes for various populations. We aim to study the demographic and COVID-19-related disparities in the door to electrocardiogram (DtE) time for patients presenting with chest pain in a diverse public city hospital. Methods We conducted a retrospective chart review of patients presenting with chest pain to the emergency department between June 1, 2019 and July 31, 2022. Data regarding age, sex, race, COVID-19 status, and DtE time were collected. Wilcoxon rank sum and Kruskal Wallis tests were used to compare medians. Linear regression was performed to further understand the relationship between age and DtE time. Results Of 10,918 patients, 51% were female (age: 49 +/- 17) and 49% were male (age: 48 +/- 16). A significantly lower median DtE time was noted in males (z=2, p=0.045), patients without COVID-19 (z= -2.84, p=0.004) and in age less than 45 years (z=2.38, p=0.017). In a linear regression adjusting for age, sex, race, and COVID-19 status, advancing age was directly correlated with greater DtE time. For every 10-year increase in age, the DtE time increased by 6.2 minutes (p<0.001). Conclusion DtE time was longer in females and in patients with COVID-19. No race-based disparities were found in this analysis. Paradoxically, younger patients presenting with chest pain had a significantly shorter DtE time, despite a higher prevalence of acute coronary syndrome in older age groups. [Formula presented]Copyright © 2023 American College of Cardiology Foundation
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Background:Dexamethasone reduces the mortality in patients with severe COVID-19. We evaluated the decline in C-reactive protein (CRP) after the treatment with standard dose dexamethasone and its association with mortality and body mass index (BMI).Material and Methods&Results:This was a retrospective cohort of 678 patients with COVID-19 admitted to the public healthcare system of New York City between July 1st and December 31st, 2020 with laboratory-confirmed COVID-19, who received at least one dose of dexamethasone and had more than one measurement of CRP. Mortality was compared among groups stratified by BMI and CRP response. The reference group had BMI 25-34.9 kg/m2 and CRP response. Male sex, increasing age and CRP non-response were associated with higher in-hospital mortality. Patients with BMI 25-34.9 kg/m2 and CRP non-response (OR 2.71 [1.43-5.15];p=0.002) and BMI > 35 kg/m2 and CRP non-response (OR 2.64 [1.05-6.62];p=0.038) were associated with higher mortality.Conclusion:CRP non-response was associated with a higher likelihood for death after adjusting for other confounding factors. The CRP non-response rate was significantly higher in patients with severe obesity.
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INTRODUCTION: In this systematic review, we assessed the clinical outcomes, benefits, and adverse effects associated with tocilizumab use in hospitalized COVID-19 patients. We aimed to seek insight on the role of tocilizumab in COVID-19 associated hospitalization. METHODS: A literature search was conducted using the electronic database engines WHO, PubMed, and Google Scholar from December 1st 2019 to June 22nd 2020. The inclusion criteria of the primary studies for our review included: 1) RT-PCR SARS-CoV-2 positive patients/ Confirmed COVID-19 patients, 2) Age>/= 18, 3) Need for hospitalization-, 4) Use of tocilizumab for the treatment of COVID-19. The search strategy retrieved 383 studies in total, of which only 37 qualified for inclusion with a total of 677 patients. The primary outcomes analyzed in this study were patients' ?clinical improvement/recovery or stabilization?, ?clinical deterioration but alive at the end of the study? after tocilizumab administration and mortality rate. The secondary outcomes included length of hospital stay (LOS), radiological improvement, and mean change in C - reactive protein (CRP) levels before and after tocilizumab administration, mean change in ferritin levels before and after tocilizumab administration and adverse events. RESULTS: After the administration of 1 or more doses of tocilizumab, clinical improvement/recovery or stabilization was noted in 462 (68.2%) out of 677 patients, whereas 31 (4.6 %) out of 677 patients clinically deteriorated but remained alive at the end of the study. A total of 103 (15.2%) patients died. Radiological improvement was noted in 108 (69.7%) out of 155 patients, the average LOS reported ranged from 5 to 25 days, mean change in CRP levels before and after tocilizumab administration reported ranged from 5.9 mg/L to 2400 mg/L, and the mean decrease in ferritin levels before and after tocilizumab administration reported ranged from 62.08 ng/ml to 51156 ng/ml. Finally, 97 (14.3 %) out of 677 patients experienced one or more adverse events. CONCLUSIONS: In a literature review of 37 studies, Tocilizumab as a management of critically ill hospitalized patients with COVID-19, this drug was found to be associated with improvement in both survival and radiological findings. A minority of patients were reported to have adverse events.
ABSTRACT
BACKGROUND Many dental procedures produce aerosols that harbour various pathogenic micro-organisms and may pose a risk for the spread of infections between dentist and patient. The COVID-19 pandemic has led to greater concern about this risk. OBJECTIVES To assess the effectiveness of methods used during dental treatment procedures to minimize aerosol production and reduce or neutralize contamination in aerosols. SEARCH METHODS The following databases were searched on 17 September 2020: Cochrane Oral Health’s Trials Register, the Cochrane Central Register of Controlled Trials (CENTRAL) (in the Cochrane Library, 2020, Issue 8), MEDLINE Ovid (from 1946);Embase Ovid (from 1980);the WHO COVID-19 Global literature on coronavirus disease;the US National Insti tutes of Health Trials Registry (ClinicalTrials.gov);the Cochrane COVID-19 Study Register. SELECTION CRITERIA AND OUTCOMES We included randomized controlled trials (RCTs) and controlled clinical trials (CCTs) on aero sol-generating procedures (AGPs) performed by dental healthcare providers that evaluated methods to reduce contaminated aerosols in dental clinics (excluding pre-procedural mouthrinses). The primary outcomes were incidence of infection in dental staff or patients, and reduction in volume and level of contaminated aerosols in the operative environment. The secondary outcomes were cost, accessibility and feasibility. MAIN RESULTS We included 16 studies with 425 participants aged 5 to 69 years (8 studies at high risk of bias). No studies measured infection. All studies measured bacterial contamination using the surrogate outcome of colony-forming units (CFU). The results described below should be interpreted with caution, as the evidence is very low certainty due to heterogeneity, risk of bias, small sample sizes and wide confidence intervals. Moreover, we do not know the minimal clinically important difference in CFU. Use of a high-volume evacuator (HVE) may reduce bacterial contamination in aerosols less than one foot from a patient’s mouth, but not at longer distances (3 splitmouth RCTs, 122 participants). One RCT (50 participants) found that there may be no difference in CFU between a combination system (Isolite) and a saliva ejector during AGPs or after AGPs. One split-mouth RCT (10 participants) found that there may be a reduction in CFU with rubber dam at one metre and two-metre distance. One RCT of 47 dental students found use of rubber dam may make no difference in CFU at the forehead and occipital region of the operator. One split-mouth RCT (21 participants) found that rubber dam plus HVE may reduce CFU more than cotton roll plus HVE on the patient’s chest and dental unit light. One split-mouth CCT (2 participants) used a local stand-alone air cleaning system (ACS), which may reduce aerosol contamination during cavity preparation or ultrasonic scaling. Another CCT (50 participants) found that laminar flow in the dental clinic combined with a HEPA filter may reduce contamination approximately 76 cm from the floor and 20 cm to 30 cm from the patient’s mouth. Two RCTs evaluated use of anti microbial coolants during ultra sonic scaling. Compared with dis tilled water, coolant-containing chlorhexidine (CHX), cinnamon extract coolant or povidone iodine may reduce CFU. AUTHORS’ CONCLUSIONS We found no studies that evaluated disease transmission via aerosols in a dental setting;and no evidence about viral contamination in aerosols. All of the included studies measured bacterial contamination using CFU. There appeared to be some benefit from the interventions, but the available evidence is very low certainty so we are unable to draw reliable conclusions. © 2020 EDRA SpA. Tutti i diritti riservati.