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1.
PLoS One ; 17(9): e0268705, 2022.
Article in English | MEDLINE | ID: covidwho-2009683

ABSTRACT

BACKGROUND: Drug induced liver injury (DILI) is a rising morbidity amongst patients with COVID-19 clinical syndrome. The updated RUCAM causality assessment scale is validated for use in the general population, but its utility for causality determination in cohorts of patients with COVID-19 and DILI remains uncertain. METHODS: This retrospective study was comprised of COVID-19 patients presenting with suspected DILI to the emergency department of Weill Cornell medicine-affiliated Hamad General Hospital, Doha, Qatar. All cases that met the inclusion criteria were comparatively adjudicated by two independent rating pairs (2 clinical pharmacist and 2 physicians) utilizing the updated RUCAM scale to assess the likelihood of DILI. RESULTS: A total of 72 patients (mean age 48.96 (SD ± 10.21) years) were examined for the determination of DILI causality. The majority had probability likelihood of "possible" or "probable" by the updated RUCAM scale. Azithromycin was the most commonly reported drug as a cause of DILI. The median R-ratio was 4.74 which correspond to a mixed liver injury phenotype. The overall Krippendorf's kappa was 0.52; with an intraclass correlation coefficient (ICC) of 0.79 (IQR 0.72-0.85). The proportion of exact pairwise agreement and disagreement between the rating pairs were 64.4%, kappa 0.269 (ICC 0.28 [0.18, 0.40]) and kappa 0.45 (ICC 0.43 [0.29-0.57]), respectively. CONCLUSION: In a cohort of patients with COVID-19 clinical syndrome, we found the updated RUCAM scale to be useful in establishing "possible" or "probable" DILI likelihood as evident by the respective kappa values; this results if validated by larger sample sized studies will extend the clinical application of this universal tool for adjudication of DILI.


Subject(s)
COVID-19 , Chemical and Drug Induced Liver Injury , Causality , Chemical and Drug Induced Liver Injury/epidemiology , Chemical and Drug Induced Liver Injury/etiology , Humans , Retrospective Studies
2.
J Clin Pharm Ther ; 47(10): 1591-1599, 2022 Oct.
Article in English | MEDLINE | ID: covidwho-1886686

ABSTRACT

WHAT IS KNOWN AND OBJECTIVE: The scope of clinical pharmacy services has changed during COVID-19 pandemic with the view to mitigating both exposure and spread of the virus. The performance of novel pandemic-driven services such as tele-pharmacy has remained unexplored, until now. The aim of this study is to investigate the perceptions of healthcare providers of the impact of tele-pharmacy services provided in critical care units during COVID-19. METHODS: A qualitative study of semi-structured interviews conducted with healthcare practitioners who worked in COVID-19 intensive care units and remotely interacted with clinical pharmacists at the Weill Cornell-affiliated Hamad Medical Corporation, Doha, Qatar. Random sampling technique was employed to recruit participants, with the resultant interview guide piloted before commencement of data collection process. RESULTS AND DISCUSSION: From a total 129 and 200 physicians and nurses, respectively, 20 interviews were conducted with physicians (n = 15), and nurses (n = 5). From these interactions, a number of major themes emerged including: satisfactory understanding across clinical environment and personnel (physician and nurses) about remote clinical pharmacists' roles; additional robust feedback on the perception of the remote clinical pharmacy service; an understanding by 'frontline' health personnel on the discernible differences between remote and in-person coverage of clinical pharmacists; a reflection by both physicians and nurses on the novel challenges involved in the implementation of such pandemic-driven service; and solutions to overcome these challenges. WHAT IS NEW AND CONCLUSION: In this novel qualitative study of pandemic-driven tele-pharmacy service, we found a positive perception amongst healthcare practitioners towards this service; with residual challenges that will need further evaluation by large sampled sized surveys or mixed methods research.


Subject(s)
COVID-19 , Community Pharmacy Services , Pharmacy Service, Hospital , Attitude of Health Personnel , Critical Care , Humans , Pandemics , Pharmacists , Professional Role
3.
EuropePMC;
Preprint in English | EuropePMC | ID: ppcovidwho-328582

ABSTRACT

Background: The scope of clinical pharmacy services has changed during the COVID-19 pandemic with the view to mitigating both exposure and spread of the virus. The performance of novel pandemic-driven services such as tele-pharmacy has remained unexplored, until now. To investigate the perceptions of healthcare providers of the impact of tele-pharmacy services provided in critical care units during COVID-19. Methods: A qualitative study of semi-structured interviews conducted with healthcare practitioners who worked in COVID-19 intensive care units and remotely interacted with clinical pharmacists at the Weill Cornell-affiliated Hamad Medical Corporation, Doha Qatar. A random sampling technique was employed to recruit participants, with the resultant interview guide piloted before the commencement of the data collection process. Results: From a total of 129 and 200 Physicians and nurses respectively. 20 interviews were conducted with physicians (n=15), and nurses (n=5). From these interactions, a number of major themes emerged including satisfactory understanding across clinical environment and personnel (physician and nurses) about remote clinical pharmacists’ roles;additional robust feedback on the perception of the remote clinical pharmacy service;an understanding by “frontline” health personnel on the discernible differences between remote and in-person coverage of clinical pharmacists;a reflection by both physicians and nurses on the novel challenges involved in the implementing of such pandemic-driven service;and solutions to overcome these challenges. Conclusion: In this novel qualitative study of pandemic-driven tele-pharmacy service, we found a positive perception amongst healthcare practitioners towards this service;with residual challenges that will need further evaluation by large sampled sized surveys or mixed methods research.

4.
IDCases ; 26: e01293, 2021.
Article in English | MEDLINE | ID: covidwho-1450119

ABSTRACT

Mucormycosis has multiple clinical phenotypes, which are more common in immunocompromised patients, especially those with diabetes mellitus. Debilitating rhino-orbital-cerebral and pulmonary infections by far represent the most typical clinical phenotypes associated with these fungi. Mucormycosis is an uncommon infection; however, there have been isolated sporadic tiny outbreaks around the world. With the substantial increase in COVID-19 cases in India, there is a parallel increase in the number of cases of Mucormycosis. A few reports raising unusual concomitant mucormycosis in COVID-19 patients have raised a possible association between the two diseases. We report a 59-year-old male with an established history of uncontrolled diabetes mellitus admitted to the hospital with severe COVID-19 pneumonia (severity ascertained according to WHO classification) treated with steroids and discharged home following full recovery. However, one week later, he presented with right eye ophthalmoplegia and complete loss of vision, which was subsequently established as orbital Mucormycosis. This case highlights the need for heightened awareness of this atypical secondary infection (especially systemic mycosis) in patients recovering from COVID-19 infection.

5.
Eur J Clin Invest ; 51(9): e13645, 2021 Sep.
Article in English | MEDLINE | ID: covidwho-1286673

ABSTRACT

BACKGROUND: Colchicine was recently repurposed for the management of coronavirus disease 2019 (COVID-19). This rapid review and meta-analysis aimed to assess colchicine's impact on mortality outcomes in COVID-19 patients. MATERIALS AND METHODS: We systematically searched PubMed, EMBASE, Google Scholar since their inception till 25/03/2021 for observational or controlled studies that reported mortality as an outcome. The mortality odd ratios were generated with their corresponding 95% confidence intervals utilizing the random-effects model. RESULTS: Nine studies comprising 5522 patients met our inclusion criteria. Our meta-analysis revealed significantly lower mortality in the colchicine group (OR 0.35, 95% CI 0.25-0.48, I2 0%) compared with controls. A subgroup analysis limited to hospitalized patients (OR 0.35, 95% CI 0.25-0.50, I2 0%) revealed similarly lower mortality in the colchicine group. CONCLUSIONS: This meta-analysis suggests a mortality benefit with colchicine when used in the treatment of COVID-19 patients. The majority of included studies were observational; thus, the findings of this review need to be further supported by the results of ongoing trials.


Subject(s)
COVID-19/drug therapy , Colchicine/therapeutic use , Tubulin Modulators/therapeutic use , COVID-19/mortality , Humans , Odds Ratio , SARS-CoV-2
6.
Front Cardiovasc Med ; 7: 598846, 2020.
Article in English | MEDLINE | ID: covidwho-1067650

ABSTRACT

Background: Recent studies revealed a high prevalence of venous thromboembolism (VTE) events in coronavirus disease 2019 (COVID-19) patients, especially in those who are critically ill. Available studies report varying prevalence rates. Hence, the exact prevalence remains uncertain. Moreover, there is an ongoing debate regarding the appropriate dosage of thromboprophylaxis. Methods: We performed a systematic review and proportion meta-analysis following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. We searched PubMed and EMBASE for studies exploring the prevalence of VTE in critically ill COVID-19 patients till 25/07/2020. We pooled the proportion of VTE. Additionally, in a subgroup analysis, we pooled VTE events detected by systematic screening. Finally, in an exploratory analysis, we compared the odds of VTE in patients on prophylactic compared with therapeutic anticoagulation. Results: The review comprised 24 studies and over 2,500 patients. The pooled proportion of VTE prevalence was 0.31 [95% confidence interval (CI) 0.24, 0.39; I 2 94%], of VTE utilizing systematic screening was 0.48 (95% CI 0.33, 0.63; I 2 91%), of deep venous thrombosis was 0.23 (95% CI 0.14, 0.32; I 2 96%), and of pulmonary embolism was 0.14 (95% CI 0.09, 0.20; I 2 90%). Exploratory analysis of few studies, utilizing systematic screening, VTE risk increased significantly with prophylactic, compared with therapeutic anticoagulation [odds ratio (OR) 5.45; 95% CI 1.90, 15.57; I 2 0%]. Discussion: Our review revealed a high prevalence of VTE in critically ill COVID-19 patients. Almost 50% of patients had VTE detected by systematic screening. Higher thromboprophylaxis dosages may reduce VTE burden in this patient's cohort compared with standard prophylactic anticoagulation; however, this is to be ascertained by ongoing randomized controlled trials.

7.
Medicine (Baltimore) ; 99(36): e21911, 2020 Sep 04.
Article in English | MEDLINE | ID: covidwho-752029

ABSTRACT

BACKGROUND: Severe acute respiratory syndrome coronavirus 2 (SARS-COV2) infection is a recently emerged viral infection causing predominantly mild upper respiratory symptoms. However, in some instances, it might result in acute respiratory distress syndrome (ARDS) that poses a significant mortality risk. ARDS is postulated to be mediated by a surge of pro-inflammatory cytokines and chemokines, leading to a dysregulated hyper inflammatory response. Colchicine being an anti-inflammatory agent, might mitigate this dysregulated response. Thus, in the absence of therapeutic options available to manage coronavirus disease 2019 (COVID-19), it is imperative to ascertain the effect of colchicine on improving outcomes in COVID-19 patients. METHOD: We will perform a systematic review including a search of the following databases: PubMed, EMBASE, MEDLINE, Clinicaltrials.gov, Cochrane library, and google scholar since inception. We will include randomized controlled trials exploring the effect of colchicine on the efficacy and safety outcomes of COVID-19 patients. Subsequently, we will perform a meta-analysis utilizing the random-effects to ascertain the effect of colchicine on reducing COVID-19 related mortality (primary endpoint) and other efficacy and safety outcomes. RESULTS: Our review results are anticipated in early 2021 (based on the completion of several ongoing randomized controlled trial). Our review results will be published in a peer-reviewed journal. CONCLUSION: This systematic review and meta-analysis, is exploring the effect of colchicine on the efficacy and safety outcomes of COVID-19 patients. If colchicine proved to be effective, it would be a significant milestone in the management of COVID-19, a disease with limited available therapeutic options. PROSPERO REGISTRATION NUMBER: CRD42020191086.


Subject(s)
Anti-Inflammatory Agents/therapeutic use , Colchicine/therapeutic use , Coronavirus Infections/drug therapy , Pneumonia, Viral/drug therapy , Anti-Inflammatory Agents/administration & dosage , Anti-Inflammatory Agents/adverse effects , Betacoronavirus , COVID-19 , Colchicine/administration & dosage , Colchicine/adverse effects , Humans , Pandemics , Randomized Controlled Trials as Topic , Research Design , SARS-CoV-2
9.
J Drug Target ; 28(7-8): 683-699, 2020.
Article in English | MEDLINE | ID: covidwho-669622

ABSTRACT

The COVID-19 pandemic is caused by the severe acute-respiratory-syndrome-coronavirus-2 that uses ACE2 as its receptor. Drugs that raise serum/tissue ACE2 levels include ACE inhibitors (ACEIs) and angiotensin-II receptor blockers (ARBs) that are commonly used in patients with hypertension, cardiovascular disease and/or diabetes. These comorbidities have adverse outcomes in COVID-19 patients that might result from pharmacotherapy. Increasing ACE2 could potentially increase the risk of infection, severity or mortality in COVID-19 or it might be protective as it forms angiotensin-(1-7) which exhibits anti-inflammatory/anti-oxidative effects and prevents diabetes- and/or hypertension-induced end-organ damage. Thus, there existed clinical uncertainty. Here, we review studies implicating 15 classes of drugs in increasing ACE2 levels in vivo and the available literature on the clinical safety of these drugs in COVID-19 patients. Further, in a re-analysis of clinical data from a meta-analysis of 9 studies, we show that ACEIs/ARBs usage was not associated with an increased risk of all-cause mortality. Literature suggests that ACEIs/ARBs usage generally appears to be clinically safe though their use in severe COVID-19 patients might increase the risk of acute renal injury. For definitive clarity, further clinical and mechanistic studies are needed in assessing the safety of all classes of ACE2 raising medications.


Subject(s)
Coronavirus Infections/drug therapy , Peptidyl-Dipeptidase A/metabolism , Pneumonia, Viral/drug therapy , Angiotensin Receptor Antagonists/adverse effects , Angiotensin Receptor Antagonists/pharmacology , Angiotensin-Converting Enzyme 2 , Angiotensin-Converting Enzyme Inhibitors/adverse effects , Angiotensin-Converting Enzyme Inhibitors/pharmacology , Animals , Betacoronavirus/isolation & purification , COVID-19 , Cardiovascular Diseases/complications , Cardiovascular Diseases/drug therapy , Coronavirus Infections/mortality , Coronavirus Infections/physiopathology , Diabetes Mellitus/drug therapy , Diabetes Mellitus/physiopathology , Humans , Pandemics , Peptidyl-Dipeptidase A/drug effects , Pneumonia, Viral/mortality , Pneumonia, Viral/physiopathology , Risk Factors , SARS-CoV-2
10.
Am J Trop Med Hyg ; 103(2): 815-821, 2020 08.
Article in English | MEDLINE | ID: covidwho-539658

ABSTRACT

The COVID-19 pandemic has resulted in significant morbidity, mortality, and strained healthcare systems worldwide. Thus, a search for modalities that can expedite and improve the diagnosis and management of this entity is underway. Recent data suggested the utility of lung ultrasound (LUS) in the diagnosis of COVID-19 by detecting an interstitial pattern (B-pattern). Hence, we aimed to pool the proportion of various reported lung abnormalities detected by LUS in symptomatic COVID-19 patients. We conducted a systematic review (PubMed, MEDLINE, and EMBASE until April 25, 2020) and a proportion meta-analysis. We included seven studies examining the role of LUS in 122 COVID-19 patients. The pooled proportion (PP) of B-pattern detected by lung ultrasound (US) was 0.97 (95% CI: 0.94-1.00 I 2 0%, Q 4.6). The PP of finding pleural line abnormalities was 0.70 (95% CI: 0.13-1.00 I 2 96%, Q 103.9), of pleural thickening was 0.54 (95% 0.11-0.95 I 2 93%, Q 61.1), of subpleural or pulmonary consolidation was 0.39 (95% CI: 0.21-0.58 I 2 72%, Q 17.8), and of pleural effusion was 0.14 (95% CI: 0.00-0.37 I 2 93%, Q 27.3). Our meta-analysis revealed that almost all SARS-CoV-2-infected patients have abnormal lung US. The most common abnormality is interstitial involvement depicted as B-pattern. The finding from our review highlights the potential role of this modality in the triage, diagnosis, and follow-up of COVID-19 patients. A sizable diagnostic accuracy study comparing LUS, computed tomography scan, and COVID-19-specific tests is warranted to further test this finding and to delineate the diagnostic and prognostic yield of each of these modalities.


Subject(s)
Coronavirus Infections/diagnostic imaging , Pneumonia, Viral/diagnostic imaging , Point-of-Care Systems , Ultrasonography , Betacoronavirus , COVID-19 , Humans , Lung/diagnostic imaging , Lung/pathology , Pandemics , Pleural Effusion , SARS-CoV-2
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