ABSTRACT
Objective: To compare the respiratory complications of COVID-19 among patients with rheumatological conditions taking bDMARDs and csDMARDs at Pak Emirates Military Hospital Rawalpindi. Study Design: Comparative prospective study. Place and Duration of Study: Pak Emirates Military Hospital, Rawalpindi Pakistan from Mar to May 2020. Methodology: Patients diagnosed with COVID-19 on polymerase chain reaction having previously rheumatological conditions managed either with bDMARD or cs DMARD were included in the study. They were followed up for three weeks after the positive polymerase chain reaction. Complications leading to the use of oxygen or ICU support or death were compared in both groups of patients. Results: A total of 82 patients with any rheumatological condition managed either with bDMARD or csDMARD tested positive for covid-19 on polymerase chain reaction and were included in the final analysis. 30 (36.6%) patients were taking bDMARDs while 52 (63.4%) were taking csDMARD. In addition, 4 (4.8%) low dose oxygen therapy, 5 (6.1%) required moderate dose oxygen therapy, while 5 (6.1%) required severe dose oxygen therapy or intensive care unit support. 2 (2.4%) patients died within the three weeks. The requirement of moderate or severe dose oxygen and intensive care unit support was found statistically significantly more in the group taking csDMARDS. Conclusion: The presence of complications of COVID-19 and the requirement of oxygen and intensive care unit support were present in some of the patients taking DMARDs. Among the DMARDs, bDMARDs were less linked with complications, but large studies with better design required better results. © 2022, Army Medical College. All rights reserved.
ABSTRACT
Introduction & Objectives: Minimally invasive transurethral therapies for benign prostatic hypertension are becoming increasingly common in Europe and America. They may be performed under local anaesthetic and provide a good alternative to invasive procedures in a COVID era. REZUM, a minimally invasive transurethral water-vapor therapy, has been shown to be a safe and effective treatment for BPH, especially where preserved sexual function is a priority. Although short-term clinical outcomes are promising, long-term data from robust studies is lacking. In Australia, there are few providers of REZUM, which utilises steam injections to reduce prostatic tissue. This study aims to investigate the safety and efficacy of REZUM in an Australian cohort. Methods: A clinical audit was conducted of 50 patients who underwent REZUM to treat symptoms of BPH over a 12-month period. Procedures were performed under general anaesthetic. Demographics, comorbidities, sexual function, prostate volume, PSA, voiding flow rate, post-void residual volume and International Prostate Symptom Score were extracted from medical records, in addition to patient's reasons for seeking minimally invasive treatment. Corresponding post-operative data was collected. Descriptive statistics of the cohort were obtained using Stata 16.0. Paired t-test was used to identify if there was a significant difference between IPSS scores pre- and postprocedure Results: Patients accessing treatment ranged from 48 to 84 years (mean 64.6). Median prostate volume was 55mL (inter-quartile range 45-78mls) and mean International Prostate Symptom Score (IPSS) was 20.3. 28% of the cohort cited concern for ejaculatory function, either from medication side effects or TURP, as their primary reason for seeking minimally invasive treatment. A further 25% of the cohort was additionally concerned about other side effects from medications and/or TURP or had experienced medication failure. The mean follow up period was 6 months (range 6-weeks-26 months). 69% of men were satisfied with their symptom improvement at the time of review, with the expectation of ongoing improvement in men who had attended a 6-week post-operative review only. Postprocedure mean IPSS was 7.9 (range 2-33). Mean reduction in IPSS score post-procedure was 12.7 points (p<0.001). 3 men experienced complications (retention, infection, bulbar stricture). Conclusions: REZUM provides a safe alternative to traditional invasive prostatic treatments. It may be performed under local anaesthetic, providing an effective alternative in a COVID era. Men concerned about medications, more invasive treatments and ejaculatory dysfunction are increasingly seeking relief from this minimally invasive option and experiencing good outcomes including significant symptom improvement sustained over medium-term follow up.
ABSTRACT
Telemedicine refers to providing healthcare from one site to another remote site, through information technologies, and has been advocated by the World Health Organisation. Telemedicine has been found to be cost-effective, reducing travel and improving satisfaction as compared to face-to-face appointments. Methods. We assessed patient satisfaction with a new Telemedicine in Addictions service as part of a feasibility randomised controlled trial of telemedicine versus face-to-face consultations (ISRCTN36756455), with addiction specialist prescribers, pre-COVID19. Opioid dependent patients prescribed opioid replacement treatment attending an outreach clinic were recruited. Telemedicine participants completed the NHS Friends and Family Test (FFT) after each consultation. We completed qualitative analysis of the free text responses. Results. Thirty Friends and Family Tests were completed, of which all participants were ‘extremely likely’ (n=19;67%) or ‘likely’ (n=11;37%) to recommend Telemedicine. Qualitative analysis themes for recommending telemedicine were ‘convenience’, ‘less travel’, ‘supportive staff’ and ‘listened to’. Patients said that everything went well, including communication. Conclusions. Our study found that patients recommend telemedicine because of convenience, less travel, good communication and supportive staff, showing this is acceptable to patients. Due to the COVID-19 pandemic, this technology will be essential for continued access to addiction services.