ABSTRACT
Bite wounds are common in the emergency departments in Denmark. As a result of the Covid-19 pandemic, more people are adopting pets and the number of hours spent at home with pets are increasing. This will probably result in more bite wounds and therefore, it is as important as ever for emergency doctors to be able to treat bite wounds appropriately. In this review, we summarise the most common types of bite wounds, how to make a thorough physical examination, what to focus on in the anamnesis, and how to treat bite wounds including when to suture and the indications for prophylactic antibiotics. © 2021, Ugeskrift for Laeger. All Rights Reserved.
ABSTRACT
The COVID-19 pandemic may not only increase mortality due to the virus but also due to the indirect effects. The disease continues to ravage health and economic metrics globally, which is likely to increase maternal and under five-year child mortality in low-and middle-income countries. This review highlights key areas of concern for maternal and under five-year child mortality due to the indirect effects of the COVID-19 pandemic in low-and middle-income countries. © 2021
ABSTRACT
Background: Population-based data regarding outcomes of coronavirus disease 2019 (COVID-19) among patients with ulcerative colitis (UC) and Crohn's disease (CD) remain limited. Methods: We conducted a population-based study investigating the outcomes of COVID-19 among patients with UC and CD in Denmark. The Danish COVID-19 IBD Database is an extensive populationbased database which prospectively monitors the disease course of laboratory-confirmed COVID-19 among patients with UC and CD. Severe COVID-19 was defined as COVID-19 necessitating intensive care unit admission, ventilator use, or death, while adverse COVID- 19 was defined as requirement of COVID-19 related hospitalization. Regression analysis was adjusted for age, sex, disease type, disease activity, cardiovascular disease, and corticosteroids. Outcomes of COVID-19 among patients with UC and CD were compared with those among the background population covering all incidents of COVID-19 in Denmark. Results: The study included 319 patients with UC and 197 patients with CD from January 28th, 2020, to April 1st, 2021. Baseline characteristics are presented in Table 1. A significantly higher risk of COVID- 19-related hospitalization was observed among patients with UC (N=46(14.4%), RR=2.49 (95%CI 1.91-3.26)) and CD (N=24(12.2%), RR=2.11 (95%CI 1.45-3.07)) as compared with the background population (N=13,306 (5.8%)). A similar pattern was observed for admission to intensive care (UC: N=8(2.51%), RR=27.88 (95%CI 13.88- 56.00);CD: N=3 (1.52%), RR=16.92 (95%CI 5.46-52.46)) (Figure 1). The association between these outcomes and IBD-related clinical characteristics and treatments is presented in Tables 2-3. As shown, none of the IBD-related medications were associated with severe COVID-19 in univariate and multivariable analysis. However, systemic steroids were found to be associated with an increased risk of adverse COVID-19 among patients with CD (adjusted odds ratio (aOR)=13.62 (95% CI 1.98-17.77)). Conclusion: This Danish population-based study on COVID-19 outcomes among patients with UC and CD demonstrated severe COVID-19 among only a minority of patients, which was not associated with IBD-related medications. Apart from systemic steroids, this study encourages continued use of IBD therapy to prevent IBD relapse and complications.
ABSTRACT
Background: The coronavirus disease 2019 (COVID-19) pandemic raised concerns among patients with ulcerative colitis (UC) and Crohn's disease (CD) fearing an increased susceptibility to infection and increased risk of poor outcomes. Furthermore, the impact of COVID-19 on subsequent health-related quality of life (HRQoL) has so far not been described. We aimed to evaluate the HRQoL in relation to the severity of COVID-19 in a cohort of survivors. Methods: We conducted a population-based study investigating the outcomes of COVID-19 among patients with UC and CD in Denmark. The Danish COVID-19 IBD Database is an extensive populationbased database which prospectively monitors the disease course of laboratory-confirmed COVID-19 among patients with UC and CD. Severe COVID-19 was defined as COVID-19 necessitating intensive care unit admission, ventilator use, or death, while adverse COVID- 19 was defined as requirement of COVID-19 related hospitalization. HRQoL was assessed using several validated questionnaires, including the EuroQol five-dimension five-level (EQ-5D-5L) questionnaire, EuroQol Visual Analogue Scale (EQ-VAS), Short Inflammatory Bowel Disease Questionnaire (SIBDQ), IBD Disability Index (IBD-DI), and IBD Fatigue Score. Results: HRQoL after COVID-19 was assessed among 137/319 (42.9%) patients with UC of whom 125 (91.2%) and 12 (8.8%) patients experienced mild and adverse COVID-19, respectively. Furthermore, HRQoL was assessed among 85/197 (43.1%) patients with CD of whom 74 (87.1%) and 11 (12.9%) patients experienced mild and adverse COVID-19, respectively. HRQoL was assessed after a median of 5.1 months (IQR 4.5-7.9) after infection. Baseline characteristics are presented according to the availability of HRQoL data in Table 1. No difference was observed in terms of EQ-5D-5L among patients with UC and CD or patients with mild, adverse, or severe COVID-19 (Table 2). Accordingly, the SIBDQ scores were similar among patients with mild, adverse or severe COVID-19 and UC (mild: median 59 (IQR 50-65), adverse: 62 (54-65), severe: 62 (54-65), p=0.89) or CD (mild: 57 (46- 65), 58 (49-64), 58 (49-64), p=0.91) as well, and no difference was observed in the subscores (Table 2). In line with these results, the IBD Disability Index (UC: median 10 (IQR 6-16), CD: 13 (6-20), p=0.16) were not associated with the severity of COVID-19 (Table 3). Finally, CD patients with adverse COVID-19 experienced more fatigue than patients with mild COVID-19 (26 (IQR 25-35) vs. 41 (IQR 29-46), p=0.03). Conclusion: This Danish population-based study found no durable impact of COVID-19 on health-related quality of life among patients with inflammatory bowel disease providing further assurance for the clinical guidelines for IBD care during the pandemic.
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Background: The vast majority of patients with ulcerative colitis (UC) and Crohn's disease (CD) who acquire coronavirus disease 2019 (COVID-19) survive the infection. Still, the long-term health consequences of COVID-19 are not well described in patients with underlying inflammatory bowel disease (IBD). Methods: We conducted a population-based study investigating the outcomes of COVID-19 among patients with UC and CD in Denmark. The Danish COVID-19 IBD Database is an extensive population-based database which prospectively monitors the disease course of laboratory-confirmed COVID-19 among patients with UC and CD. Severe COVID-19 was defined as COVID-19 necessitating intensive care unit admission, ventilator use, or death, while adverse COVID-19 was defined as requirement of COVID-19 related hospitalization. Sequelae following COVID-19 were defined as symptoms that developed during or after an infection consistent with COVID- 19, were present for more than 12 weeks, and were not attributable to alternative diagnoses. Results: The study included 319 patients with UC and 197 patients with CD from January 28th, 2020, to April 1st, 2021. Of these, a total of 137 (42.9%) and 85 (43.1%), respectively, participated in a subsequent investigation of post-COVID-19 sequelae after a median of 5.1 months (IQR 4.5-7.9) after infection (Table 1). An equal proportion of patients with UC (58 (42.3%)) and CD (39 (45.9%), p=0.60) reported persisting symptoms of COVID-19 for at least 12 weeks, consistent with the development of post-COVID-19 syndrome. The most common persisting patient-reported symptoms included fatigue (UC: 49 (35.8%), CD: 31 (36.5%), p=0.92), anosmia (UC: 37 (27.0%), CD: 25 (29.4%), p=0.70), ageusia (UC: 26 (19.0%), CD: 24 (28.2%), p=0.11), headache (UC: 19 (13.9%), CD: 16 (18.8%), p=0.32), dyspnea (UC: 19 (13.9%), CD: 16 (18.8%), p=0.32), and arthralgia (UC: 17 (12.4%), CD: 14 (16.5%), p=0.40) (Figure 1). Only discontinuation of immunosuppressive therapies for UC during COVID-19 (OR=1.50 (95% CI 1.07-10.22), p=0.01) and the severity of COVID-19 among patients with CD were independently associated with the long-term effects of COVID-19 (OR=2.76 (95% CI 1.05- 3.90), p=0.04) (Tables 2-3). Conclusion: This Danish population-based study found a high occurrence of patient-reported persisting symptoms following the acute phase of COVID-19 infection, which were associated with the discontinuation of immunosuppressive therapies for UC during COVID-19 and the severity of COVID-19 among patients with CD. These findings might have implications for planning the healthcare of patients with inflammatory bowel diseases in the post-COVID-19 era.
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Background: Whether the disease activity of ulcerative colitis (UC) and Crohn's disease (CD) is correlated with the severity of coronavirus disease 2019 (COVID-19) remains poorly investigated with only few selected cohort studies having addressed this in the past. Methods: We conducted a population-based study investigating the outcomes of COVID-19 among patients with UC and CD in Denmark. The Danish COVID-19 IBD Database is an extensive population-based database which prospectively monitors the disease course of laboratory-confirmed COVID-19 among patients with UC and CD. Severe COVID-19 was defined as COVID-19 necessitating intensive care unit admission, ventilator use, or death, while adverse COVID-19 was defined as requirement of COVID-19 related hospitalization. Clinical disease activity was measured by simple clinical colitis index and Harvey-Bradshaw Index in UC and CD, respectively. The biochemical activity was defined as C-reactive protein higher than 5 mg/L or fecal calprotectin higher than 250 μg/g. The endoscopic activity was defined as Mayo Endoscopic Subscore of at least 2 in UC, or Simple Endoscopic Score Crohn's Disease of at least 3 for CD. Sequelae following COVID-19 were defined as symptoms that (i) developed during or after an infection consistent with COVID-19, (ii) and were present for more than 12 weeks, (iii) and were not attributable to alternative diagnoses. Results: During the inclusion period between January 28th, 2020, to April 1st, 2021, the study included 319 patients with UC and 197 patients with CD who developed laboratory confirmed COVID-19. Of these, data on clinical, biochemical, and endoscopic activity were available among 265/319 (83.1%), 319/319 (100.0%), and 66/319 (20.7%) of patients with UC, respectively, and 140/197 (71.1%), 131/197 (66.5%), and 42/197 (21.3%) of patients with CD. Figures 1-2 outlines the outcomes of COVID-19 according to the degree of clinical, biochemical and endoscopic disease activity. In both UC and CD, clinical, biochemical, and endoscopic activity were not associated with adverse or severe COVID-19, nor long-term outcomes, in unadjusted nor adjusted analysis (Table 1). Conclusion: In this population-based study, we found no association between disease activity of UC or CD and severity of COVID-19. These findings have implications for the risk stratification of patients with IBD acquiring COVID-19.
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Introduction: The coronavirus disease 2019 (COVID-19) pandemic reached Denmark in early 2020. This paper presents initial intensive-care unit (ICU) experiences with COVID-19 patients at Roskilde Hospital, which was the primary recipient of COVID-19 patients in need of intensive care in the Zealand Region, Denmark.
ABSTRACT
Bite wounds are common in the emergency departments in Denmark. As a result of the Covid-19 pandemic, more people are adopting pets and the number of hours spent at home with pets are increasing. This will probably result in more bite wounds and therefore, it is as important as ever for emergency doctors to be able to treat bite wounds appropriately. In this review, we summarise the most common types of bite wounds, how to make a thorough physical examination, what to focus on in the anamnesis, and how to treat bite wounds including when to suture and the indications for prophylactic antibiotics.
ABSTRACT
Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) elicits an interferon (IFN) deficiency state, which aggravates the type I interferon deficiency and slow IFN responses, which associate with e.g. aging and obesity. Additionally, SARS-CoV-2 may also elicit a cytokine storm, which accounts for disease progression and ultimately the urgent need of ventilator support. Based upon several reports, it has been argued that early treatment with IFN-alpha2 or IFN-beta, preferentially in the early disease stage, may prohibit disease progression. Similarly, preliminary studies have shown that JAK1/2 inhibitor treatment with ruxolitinib or baricitinib may decrease mortality by dampening the deadly cytokine storm, which - in addition to the virus itself - also contributes to multi-organ thrombosis and multi-organ failure. Herein, we describe the rationale for treatment with IFNs (alpha2 or beta) and ruxolitinib emphasizing the urgent need to explore these agents in the treatment of SARS-CoV-2 - both as monotherapies and in combination. In this context, we take advantage of several safety and efficacy studies in patients with the chronic myeloproliferative blood cancers (essential thrombocythemia, polycythemia vera and myelofibrosis) (MPNs), in whom IFN-alpha2 and ruxolitinib have been used successfully for the last 10 (ruxolitinib) to 30 years (IFN) as monotherapies and most recently in combination as well. In the context of these agents being highly immunomodulating (IFN boosting immune cells and JAK1/2 inhibitors being highly immunosuppressive and anti-inflammatory), we also discuss if statins and hydroxyurea, both agents possessing anti-inflammatory, antithrombotic and antiviral potentials, might be inexpensive agents to be repurposed in the treatment of SARS-CoV-2.
Subject(s)
COVID-19 Drug Treatment , Cytokine Release Syndrome/virology , Interferons/deficiency , Interferons/therapeutic use , Janus Kinase 1/antagonists & inhibitors , Janus Kinase 2/antagonists & inhibitors , Protein Kinase Inhibitors/therapeutic use , SARS-CoV-2/pathogenicity , Animals , COVID-19/immunology , COVID-19/pathology , Clinical Trials as Topic , Cytokine Release Syndrome/immunology , Cytokine Release Syndrome/pathology , Humans , SARS-CoV-2/immunologyABSTRACT
Severely afflicted patients with the COVID-19 may become in need of mechanical ventilation. The cause of acute respiratory failure is a massive hyperinflammation in the lungs, and treatment with glucocorticoids is not recommended by the WHO. A rare haematological disease, the virus-associated haemophagocytic lymphohistiocytosis syndrome (HLS), is associated with high mortality and a similar hyperinflammation syndrome. Janus kinase (JAK) 1/2 inhibitor treatment is highly efficacious in HLS. In this review, we discuss the rationales and perspectives for using JAK1/2 inhibitors in severely afflicted patients with COVID-19 pneumonia.