Safety and clinical outcomes of remdesivir in hospitalised COVID-19 patients: a retrospective analysis of active surveillance database.

BACKGROUND: Real-world data on safety and clinical outcomes of remdesivir in COVID-19 management is scant. We present findings of data analysis conducted for assessing the safety and clinical outcomes of remdesivir treatment for COVID-19 in India. METHODS: This retrospective analysis used data from an active surveillance programme database of hospitalised patients with COVID-19 who were receiving remdesivir. RESULTS: Of the 2329 patients included, 67.40% were men. Diabetes (29.69%) and hypertension (20.33%) were the most common comorbidities. At remdesivir initiation, 2272 (97.55%) patients were receiving oxygen therapy. Remdesivir was administered for 5 days in 65.38% of patients. Antibiotics (64.90%) and steroids (47.90%) were the most common concomitant medications. Remdesivir was overall well tolerated, and total 119 adverse events were reported; most common were nausea and vomiting in 45.40% and increased liver enzymes in 14.28% patients. 84% of patients were cured/improved, 6.77% died and 9.16% showed no improvement in their clinical status at data collection. Subgroup analyses showed that the mortality rate was significantly lower in patients < 60 years old than in those > 60 years old. Amongst patients on oxygen therapy, the cure/improvement rate was significantly higher in those receiving standard low-flow oxygen than in those receiving mechanical ventilation, non-invasive ventilation, or high-flow oxygen. Factors that were associated with higher mortality were age > 60 years, cardiac disease, diabetes high flow oxygen, non-invasive ventilation and mechanical ventilation. CONCLUSION: Our analysis showed that remdesivir is well tolerated and has an acceptable safety profile. The clinical outcome of cure/improvement was 84%, with a higher improvement in patients < 60 years old and on standard low-flow oxygen.

Adolescent-Parent conflict in the era of ‘TikTok’: Case reports from Nepal

Background TikTok is a recent type of video-sharing and lip-syncing online platform that is influencing adolescents rapidly and is likely to surge in view of increased use of smart-phones, internet use, ‘Lockdown’ period due to COVID-19pandemic and increasing online transactions, teachings and daily affairs worldwide. Case presentation Two teenaged girls from southern Nepal brought by their parents with problematic use of TikTok and behavioural problems that followed .They were engrossed in the mobile application that resulted in impairment at a personal, social, educational and family functioning.In addition to that, parents did not accept it on cultural grounds. However, patients did not consider it problematic .Gradually, they developed symptoms of depression, conduct disorder and oppositional defiant disorder but did not fulfill criteria of any disorder. The provisional diagnosis of Behavioural addiction was considered and Cognitive behavioural therapy planned. These cases posed diagnostic dilemma, challenging treatment sessions and partial success. Conclusions The line between normal and abnormal use of such mobile application is hazy in context of its social acceptability and growing use. The conflict appeared between traditional values and modern means of entertainment poses therapeutic challenge. Authors advise parental involvement, psychotherapeutic means, behavioral therapy and a collaborative approach with adolescents rather than pharmacotherapy for comprehensive treatment.