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1.
ASAIO Journal ; 68:66, 2022.
Article in English | EMBASE | ID: covidwho-2032185

ABSTRACT

Background: The COVID-19 pandemic has led to a significant increase in the use of Veno-venous extracorporeal membrane oxygenation (VV ECMO) as a bridge to various outcomes including transplantation or recovery. Unlike other etiologies of acute respiratory distress syndrome (ARDS), utilization of VV ECMO in COVID-19 has been associated with longer duration of ECMO support requirements. Our team sought to evaluate outcomes associated with prolonged duration of ECMO support in this patient population. Methods: Single-center retrospective review of patients who were placed on ECMO due to COVID-19 associated ARDS. Specifically examining outcomes-mortality, transplantation and discharge rates-of patients requiring VV ECMO support more than 50 days in duration. Data collected between February 15,2020 to February 15, 2022. Results: Reviewed outcomes in 18 patients who required VV support for >50 days. Twenty three percent (n=4) mortality rate within cohort. Three patients (16%) continue to require ECMO support at time of submission. Sixty-one percent (n=11) patients were discharged, of which sixteen percent (n=3) required a lung transplant (Table). Summary: Prolonged VV ECMO at our center was associated with comparable outcomes to the national ELSO pulmonary ECMO cohort. With availability of device and staffing, prolonged ECMO runs can potentially be justified in a highly selected patient population (Table Presented).

2.
Medical Journal of Dr. D.Y. Patil Vidyapeeth ; 15(7):S49-S54, 2022.
Article in English | Scopus | ID: covidwho-2024823

ABSTRACT

Background: Severe acute respiratory illness caused by SARS-CoV-2 has been a health emergency of great concern in the year 2020. This study was undertaken to identify characteristics of hospitalized patients with Coronavirus Disease 19 (COVID-19) and hypoxia in the form of disease course and outcome with special reference to the presence or absence of comorbidities. Materials and Methods: A prospective observational study was conducted at a tertiary hospital recognized as Dedicated COVID Hospital during the period of June 2020 to September 2020. The study included a total of 249 patients of COVID-19 with hypoxia who required oxygen or noninvasive ventilation/invasive ventilation. Patients were divided into two groups as per the presence or absence of comorbidity (175 and 74 patients, respectively). Their clinical and laboratory findings, course in the hospital, and outcomes were noted. Data were analyzed using SPSS software. Results: Among all the study patients, more patients from comorbidity group presented with a N:L ratio >3.5 and raised inflammatory markers (like serum ferritin) than patients in the no comorbidity group. In patients with comorbidities, 47.43% required noninvasive or invasive ventilation as against 18.92% in those without any comorbidities. Development of deranged renal function was noted in 32.57% of patients in the comorbidity group and only 9.46% in the noncomorbid group. All except one death during the study period were in the patients with comorbidities. Conclusion: COVID-19 patients with hypoxia and the presence of comorbidities in this study had more complications and a worse outcome. © Medical Journal of Dr. D.Y. Patil Vidyapeeth 2022.

3.
Neonatology ; : 1-10, 2022.
Article in English | PubMed | ID: covidwho-2020583

ABSTRACT

INTRODUCTION: Our objective was to compare neonatal outcomes and resource use of neonates born to mothers with SARS-CoV-2 positivity during pregnancy with neonates born to mothers without SARS-CoV-2 positivity. METHODS: We conducted a two-country cohort study of neonates admitted between January 1, 2020, and September 15, 2021, to tertiary neonatal intensive care unit (NICU) in Canada and Sweden. Neonates from mothers who were SARS-CoV-2 positive during pregnancy were compared with three randomly selected NICU neonates of mothers who were not test-positive, matched on gestational age, sex, and birth weight (±0.25 SD). Subgroup analyses were conducted for neonates born <33 weeks' gestation and mothers who were SARS-CoV-2 positive ≤10 days prior to birth. Primary outcome was duration of respiratory support. Secondary outcomes were in-hospital mortality, neonatal morbidity, late-onset sepsis, receipt of breast milk at discharge, and length of stay. RESULTS: There were 163 exposed and 468 matched neonates in Canada, and 303 exposed and 903 matched neonates in Sweden. There was no statistically significant difference in invasive or noninvasive respiratory support durations, mortality, respiratory and other neonatal morbidities, or resource utilizations between two groups in both countries in entire cohort and in subgroup analyses. Receipt of breast milk at discharge was lower in the Canadian neonates of mothers who were SARS-CoV-2 positive ≤10 days before birth (risk ratio 0.68, 95% CI: 0.57-0.82). CONCLUSION: Maternal SARS-CoV-2 positivity was not associated with increased durations of respiratory support, morbidities, mortality, or length of hospital stay in Canada and Sweden among neonates admitted to tertiary NICU.

4.
Int J Health Plann Manage ; 2022.
Article in English | PubMed | ID: covidwho-2013523

ABSTRACT

The coronavirus disease 2019 (COVID-19) pandemic has caused a paradigm shift in the cancer care landscape, shifting from a palliative care approach to a need-based approach. In these current and upcoming future times, patient- and community-centred research becomes the cornerstone of collaborative assessment efforts for understanding and assessing Targeted Palliative Care (TPC) Accessibility Models for patients with oncological malignancies in resource-limited settings. This short communication focuses on the models available for TPC for the continuation of care in oncological settings in resource-limited geographic areas. Some programmes have used a Mixed Method Approach, highlighting their importance based on engagement volunteers and building trust and relationships in the community. Other studies have addressed the care system using a Rural Palliative Supportive Service Model for older adults living with life-limiting chronic illness, showing that home-based treatment for this population is feasible. Moreover, the Home Palliative Care Units (HPCU) model showed promising results in that patients cared for by HPCU had a fewer emergency visits and hospital admissions, in addition to being more likely to die at home with adequate palliation. During the ongoing pandemic, patients have experienced rapid clinical decline, requiring urgent conversations about their care wishes. They have been forced to make decisions on so-called 'Life and death' issues. In this article we discuss the advantages, disadvantages, and possible changes implemented in the context of cancer surgical care in resource-limited settings, in order to create a better assessment of geographic or demographic-based, patient- and community-centred TPC accessibility models for a more holistic development of cancer care programs.

6.
Journal of Commercial Biotechnology ; 27(1):58-76, 2022.
Article in English | EMBASE | ID: covidwho-2010465

ABSTRACT

Most vaccines have a similar method of delivery, utilizing a needle-based system to administer vaccines. Moreover, many require the maintenance of a cold chain to preserve their integrity and usability. While these options are feasible in developed parts of the world, delivering these vaccines to underdeveloped areas becomes difficult. Many vaccines go to waste due to breakages in the cold chain, leaving people without vaccinations. Furthermore, with the recent COVID-19 crisis, needs are emerging around strategies to deliver products that do not require extreme temperatures for storage and allow for efficient vaccine delivery on a mass scale. Many companies, including Pfizer, Moderna, and Johnson & Johnson, have brought to market COVID-19 vaccines. Pfizer and Moderna have found development success and profitability from their vaccine technology, both now and potentially in the future. Still, storage, administration, and waste challenges exist with these current options, creating opportunities for alternative delivery mechanisms. With these vaccines being essential for the current global situation, other administration strategies, such as BioneedleTM, could provide a valuable alternative and help mitigate the associated cold chain and sustainability issues seen with currently available options. Bioneedle Drug Delivery B.V. (BDD), a European biotechnology company, is developing a needleless vaccine-device combination product, the BioneedleTM. This technology value proposition focuses on solving the logistical issues associated with many vaccine products. These include eliminating cold-chain requirements, increasing the speed of vaccination, and reducing non-recyclable, medical waste (e.g., plastic syringes). It employs a reusable delivery system that administers multiple vaccines using biodegradable mini-implants to aid mass immunization efforts. This approach could significantly reduce plastic waste from syringes, translating to a significant sustainability benefit consistent with the United Nation's initiatives. Accordingly, BDD seeks support from a venture, corporate, government, or foundation for developing this novel delivery platform. This case aims to achieve two objectives. First, it seeks to provide an in-depth overview of the value proposition of BioneedleTM, sparking discussion around its feasibility in a real-world setting. The second involves creating dialog regarding improvements to the BioneedleTM system and other innovations that may help mitigate cold chain issues while still providing needleless delivery of vaccines. This case discussion highlights the potential of a new vaccine delivery system that various healthcare settings can use. This approach may pose a cost-effective solution to the loss of vaccines in the cold chain and address the growing concerns around plastic waste and the environment. In closing, this narrative allows for an open-forum discussion around the opportunity of introducing a new medical device platform in a thriving vaccine market. It is a learning experience that requires strategic decision-making in response to questions posed for new startups and the new vaccine technology.

7.
Frontiers in Pharmacology ; 13, 2022.
Article in English | EMBASE | ID: covidwho-2009894

ABSTRACT

Preclinical pharmacokinetics (PK) and In Vitro ADME properties of GS-441524, a potential oral agent for the treatment of Covid-19, were studied. GS-441524 was stable in vitro in liver microsomes, cytosols, and hepatocytes of mice, rats, monkeys, dogs, and humans. The plasma free fractions of GS-441524 were 62–78% across all studied species. The in vitro transporter study results showed that GS-441524 was a substrate of MDR1, BCRP, CNT3, ENT1, and ENT2;but not a substrate of CNT1, CNT2, and ENT4. GS-441524 had a low to moderate plasma clearance (CLp), ranging from 4.1 mL/min/kg in dogs to 26 mL/min/kg in mice;the steady state volume distribution (Vdss) ranged from 0.9 L/kg in dogs to 2.4 L/kg in mice after IV administration. Urinary excretion appeared to be the major elimination process for GS-441524. Following oral administration, the oral bioavailability was 8.3% in monkeys, 33% in rats, 39% in mice, and 85% in dogs. The PK and ADME properties of GS-441524 support its further development as an oral drug candidate.

8.
Journal of Clinical Oncology ; 40(16), 2022.
Article in English | EMBASE | ID: covidwho-2009551

ABSTRACT

Background: Despite mitigation and treatment strategies, COVID-19 continues to negatively impact patients (pts) with cancer. Identifying factors that remain consistently associated with morbidity and mortality is critical for risk identification and care delivery. Methods: Using CCC19 registry data through 12/31/2021 we report clinical outcomes (30-day case fatality rate [CFR], mechanical ventilation use (MV), intensive care unit admission (ICU), and hospitalization) in adult pts with cancer and laboratory confirmed SARS-CoV-2, stratified by patient, cancer, and treatment-related factors. Results: In this cohort of 11,417 pts (with 4% reported vaccination prior to COVID-19), 55% required hospitalization, 15% ICU, 9% MV, and 12% died. Overall outcome rates remained similar for 2020 and 2021 (Table). Hydroxychloroquine was utilized in 11% and other anti-COVID-19 drugs (remdesivir, tocilizumab, convalescent plasma, and/or steroids) in 30%. Higher CFRs were observed in older age, males, Black race, smoking (14%), comorbidities (pulmonary [17%], diabetes mellitus [16%], cardiovascular [19%], renal [21%]), ECOG performance status 2+ (31%), co-infection (25%), especially fungal (35%), and initial presentation with severe COVID-19 (48%). Pts with hematologic malignancy, active/ progressing cancer status, or receiving systemic anti-cancer therapy within 1-3 months prior to COVID-19 also had worse CFRs. CFRs were similar across anti-cancer modalities. Other outcomes (ICU, MV, hospitalization) followed similar distributions by pt characteristics. Conclusions: Unfavorable outcome rates continue to remain high over 2 years, despite fewer case reports in 2021 owing to multiple factors (e.g., pandemic dynamics, respondent fatigue, overwhelmed healthcare systems). Pts with specific socio-demographics, performance status, comorbidities, type and status of cancer, immunosuppressive therapies, and COVID-19 severity at presentation experienced worse COVID-19 severity;and these factors should be further examined through multivariable modeling. Understanding epidemiological features, patient and cancer-related factors, and impact of anti-COVID-19 interventions can help inform risk stratification and interpretation of results from clinical trials.

11.
Journal of Obstetrics and Gynaecology Canada ; 44(5):607-608, 2022.
Article in English | EMBASE | ID: covidwho-2004257

ABSTRACT

Objectives: Evaluate peripartum outcomes following COVID-19 vaccination during pregnancy. Methods: Ontario population-based retrospective cohort between December 14, 2020 and September 30, 2021 using linkage of provincial birth registry and COVID-19 immunization databases. Poisson regression was used to generate risk ratios (RR) and 95% confidence intervals (CI), adjusted for temporal, socio-demographic, and clinical factors using propensity scores. Obstetric (postpartum hemorrhage, chorioamnionitis, cesarean birth) and newborn (NICU admission and 5-minute Apgar<7) outcomes were compared for those who received ≥1 dose of COVID-19 vaccine during pregnancy with 2 unexposed groups—Group 1: individuals vaccinated postpartum, Group 2: never vaccinated. Results: Among 97 590 individuals, 22 660 (23%) received ≥1 dose of vaccine during pregnancy (64% received dose 1 in 3rd trimester). Compared with those vaccinated postpartum, we found no increased risks of postpartum hemorrhage (aRR 0.91, 95% CI 0.82–1.02);chorioamnionitis (aRR 0.92, 95% CI 0.70–1.21);or cesarean (aRR 0.92, 95% CI 0.89–0.95) following COVID-19 vaccination, nor any increased risk of NICU admission or 5-minute Apgar <7. All findings were similar when compared with individuals who did not receive COVID-19 vaccination at any point. We did not observe any difference according to vaccine product, number of doses received during pregnancy, or trimester of dose 1. Conclusions: As of late 2021, there is limited evidence from comparative studies in large populations on outcomes following COVID-19 vaccination during pregnancy. Our study of births up to September 30, 2021 did not identify any increased adverse peripartum outcomes associated with later pregnancy COVID-19 vaccination. Once more individuals vaccinated earlier in pregnancy deliver, we will report on other important obstetric and perinatal outcomes. Keywords: COVID-19 vaccine;pregnancy;epidemiology

12.
Journal of General Internal Medicine ; 37:S468, 2022.
Article in English | EMBASE | ID: covidwho-1995849

ABSTRACT

CASE: A 23-year-old female with a history of congenital deafness and HLAB27 positivity presented for two weeks of diffuse arthralgias, fever, and nausea. She had a history of an erythematous rash around her eyes and upper chest that had resolved with prednisone;however, her other symptoms persisted. She denied known tick exposures, drug use, sick contacts, or travel, but had recently been hiking. On presentation, she was febrile to 38.8°C and tachycardic to 130 beats/min. Her labs were notable for an AST of 232 U/L, ALT of 266 U/L, LDH of 680 U/L, haptoglobin <10 mg/dL, and ferritin of 12,230 ng/mL, with no cytopenias or leukocytosis. Her CRP was 127 mg/dL and ESR was normal. Her troponin and BNP were both elevated, to 54 ng/L and 468 pg/mL respectively. ANA and RF titers was negative. Viral studies including EBV, CMV, and SARSCoV-2 as well as bacterial studies were negative. She was started on doxycycline for possible tick-borne infection, but titers returned negative. Echocardiography and chest x-ray were unremarkable. CT scan demonstrated nonspecific para-aortic and mesenteric lymphadenopathy. The patient's presentation and labs were consistent with adult-onset Still's disease (AOSD), meeting the Yamaguchi criteria for diagnosis. She was started on IV hydrocortisone and anakinra with symptomatic improvement. Her liver function testing worsened due to concerns for macrophage activation syndrome (MAS). She was treated with ruxolitinib with gradual improvement in her liver function, followed by tofacitinib. She made a full recovery on discharge. IMPACT/DISCUSSION: Due to its rarity, AOSD can be challenging to diagnose. This case highlighted the key manifestations and distinguishing characteristics of the disorder. The patient presented with fever, rash, and polyarthralgias. While the location of the rash in AOSD varies, the upper chest as seen in this case is typical. While this patient did not have cytopenia or leukocytosis, she did have elevated transaminases and a disproportionately elevated ferritin, a hallmark of AOSD. Importantly, ANA and RF titers were negative, which helps to differentiate AOSD from other autoimmune disorders. The case also demonstrated a feared complication of AOSD, MAS, a form of hemophagocytic lymphohistiocytosis that occurs in 10-15% of patients with AOSD. This case highlighted the importance of remaining vigilant for MAS, as the patient's liver function continued to decline despite symptomatic improvement. While MAS is difficult to diagnose, hyperferritinemia and pancytopenia are thought to be relatively strong indicators. CONCLUSION: AOSD is a rare and debilitating disease, with an illness script that has significant overlap with other diseases. In addition to the combination of polyarthralgias, rash, and fevers, a markedly elevated ferritin is a strong indicator of AOSD. ANA and RF titers will be negative. It is crucial to remain vigilant for complications of the disease, such as MAS.

13.
American Journal of the Medical Sciences ; 364(1):E18-6, 2022.
Article in English | Web of Science | ID: covidwho-1981014

ABSTRACT

Background: The coronavirus disease 2019 (COVID-19) is responsible for one of the largest public health crises the United States has seen to date. This study explores the outcomes of African American and non-African American COVID-19-positive patients hospitalized in rural Southwest Georgia to identify differences in morbidity and mortality between the groups. Methods: We performed a retrospective cohort analysis among adults aged >= 18 years admitted with COVID-19 between March 2, 2020 and June 17, 2020 at Phoebe Putney Health System. Data on demographics, comorbidities, presenting symptoms, and hospital course were obtained. Patients were divided into two groups: African Americans and non-African Americans. We examined differences in patient characteristics between groups using chi-square tests for categorical variables, t test for parametric continuous variables, and Wilcoxon rank-sum tests for non-parametric continuous variables. Statistical Analysis Software (SAS) version 9.4 was used for statistical analysis. Results: Among 710 patients, median age was 63 years, 43.8% were males, and 83.3% were African Americans. African Americans had higher prevalence of obesity and hypertension, were more likely to present with fever, and present with longer duration of symptoms prior to presentation. In-hospital mortality was similar between the groups, as was need for mechanical ventilation, ICU care, and new dialysis. African Americans were more likely to be discharged home compared to non-African Americans. Conclusions: There was no difference in in-hospital mortality;however, African Americans had disproportionately higher hospitalizations, likely to significantly increase the morbidity burden in this population. Urgent measures are needed to address this profound racial disparity.

14.
Gastroenterology ; 162(7):S-382-S-383, 2022.
Article in English | EMBASE | ID: covidwho-1967303

ABSTRACT

Introduction: Although Coronavirus disease 2019 (COVID-19) primarily involves the respiratory system, it can also progress to a multisystem illness frequently involving the gastrointestinal tract. When an infection ensues and disrupts the checks and balances system within the liver, it can lead to injury, tissue damage, remodeling, and chronic liver disease. It is commonly observed that COVID elevates liver function tests (LFTs) during an acute infection, but not much has been published about the effects once the infection clears. We investigated the elevated LFT during COVID and different health and hospital related outcomes. To our knowledge, this is the first report of long term liver enzyme elevations in COVID patients. Method: A retrospective cohort study was performed examining patients with COVID between 7/1/2020-11/30/2020 within our hospital system. Of the 1370 patients, we compared LFTs at minimum 3 months prior to COVID, during COVID, and a minimum 3 months after COVID as well as their outcomes. 18 patients were excluded as they were outliers based on interquartile range. We defined elevated LFTs being 2x the upper limit of normal LFT values. We used pairwise Wilcoxon rank sum test to compare continuous variables and Chi-Square test to compare categorical variables. Unadjusted and adjusted association of elevated LFT were analyzed using logistic regression model. Result: A total of 1352 patients were analyzed, 657 (48.5%) were male and 695 (51.5%) were female. 249 patients were found to have elevated LFTs during hospitalization. Patients with elevated LFTs were more likely to have a longer length of stay (aOR 1.016, 95% CI 1.002 – 1.029, p <0.0001), more likely to be admitted to the ICU (aOR 1.54, 95% CI, 1.251 – 1.899, p <0.0001) and more likely to be intubated (aOR 2.34, 95% CI, 1.051 – 3.6, p< 0.0001) as compared to patients with normal LFTs. Patients with elevated LFTs also had significantly lower survival compared to patients with normal LFTs (aOR 0.38, 95% CI 0.25-0.59, p<0.0001). Pairwise comparisons of the LFTs before and after COVID showed no statistically significant difference between AST, ALT, ALP, and bilirubin, p = 0.43, 0.062, 0.25, and 0.58 respectfully. However, there was a significant difference between AST, ALT, and ALP during COVID as compared to before and after COVID infection (p<0.0001). Conclusion: COVID patients with elevated LFTs during hospitalization exhibited less survival and longer hospital stay and ventilation use and hospital care. Elevated LFTs lasted several months even after recovery from the respiratory infection. Larger prospective observational studies are needed to confirm these associations

15.
Computer Science Journal of Moldova ; 30(2):214-222, 2022.
Article in English | Scopus | ID: covidwho-1965236

ABSTRACT

The Coronavirus Pandemic triggered by SARS-CoV-2 has wreaked havoc on the planet and is expanding exponentially. While scanning methods, including CT scans and chest X-rays, are commonly used, artificial intelligence implementations are also deployed for COVID-based pneumonia detection. Due to image biases in X-ray data, bilateral filtration and Histogram Equalization are used followed by lung segmentation by a U-Net, which successfully segmented 83.2% of the collected dataset. The segmented lungs are fed into a Quadruplet Network with SqueezeNet encoders for increased computational efficiency and high-level embeddings generation. The embeddings are computed using a Multi-Layer Perceptron and visualized by T-SNE (T-Distributed Stochastic Neighbor Embedding) scatterplots. The proposed research results in a 94.6% classifying accuracy which is 2% more than the baseline Convolutional Neural Network and a 90.2% decrease in prediction time. © 2022 by CSJM;Pranshav Gajjar, Naishadh Mehta, Pooja Shah

16.
J Am Acad Orthop Surg Glob Res Rev ; 6(7), 2022.
Article in English | PubMed | ID: covidwho-1954621

ABSTRACT

INTRODUCTION: There has been increasing interest in the use of stemless humeral implants for total shoulder arthroplasty when compared with both short-stem (SS) and standard-length implants. Although evidence for decreased surgical time and blood loss exists for stemless versus standard-length stems, far less literature exists comparing these clinical parameters for stemless versus SS implants. METHODS: A retrospective review of consecutive anatomic total shoulder arthroplasty (aTSA) cases conducted by a single, fellowship-trained shoulder surgeon was undertaken from January 2016 through January 2022 with the exception of March 2020 through January 2021 secondary to the COVID-19 pandemic. Demographic patient and surgical data, including age, sex, body mass index, American Society of Anesthesiologists score, age-adjusted Charlson Comorbidity Index, prior ipsilateral shoulder arthroscopy, surgical time, use of a Hemovac drain and/or tranexamic acid, hospital length of stay (LOS), and both postoperative day #1 (POD 1) and discharge visual analog scores. The use of a stemless or SS implant was recorded. Intraoperative total blood volume loss (TBVL) was calculated, in addition to the need for either intraoperative or postoperative transfusions. Nonparametric analysis of covariance was used to examine effects of stemless versus SS aTSA on surgical time and intraoperative TBVL adjusted for demographic, clinical, and surgical variables. RESULTS: There were 47 SS and 83 stemless anatomic implants included, of which 74 patients (57%) overall were women. The median surgical time for the stemless cohort was 111 minutes (IQR 96-130) versus 137 minutes (IQR 113-169) for the SS cohort (P < 0.00001). The median intraoperative TBVL for the stemless cohort was 298.3 mL (IQR 212.6-402.8) versus 359.7 mL (IQR 253.9-415.0) for the SS cohort (P = 0.05). After multivariable regression analysis, use of stemless humeral implants was independently associated with both decreased surgical time and intraoperative blood loss (P < 0.001 and P = 0.005, respectively). There was a shorter median hospital LOS in the stemless group (2 days [IQR 1-2] versus 2 days [IQR 2-3], P = 0.03). The visual analog score pain score at discharge was lower among the stemless cohort (0 [IQR 0-3] versus 4 [IQR 2-6], P < 0.00001). Increased surgical time was associated with intraoperative TBVL (r = 0.340, P < 0.0001). DISCUSSION: Stemless aTSA is associated with a markedly decreased surgical time and intraoperative TBVL when compared with a SS aTSA. Furthermore, the use of a stemless implant results in a shorter hospital LOS and lower discharge pain scores.

17.
Circulation: Cardiovascular Quality and Outcomes ; 15, 2022.
Article in English | EMBASE | ID: covidwho-1938119

ABSTRACT

Background: Different arrhythmias have been reported in patients with COVID-19 due to the complication of the disease, and medications used in the management of COVID-19. Remdesivir was approved by FDA for the management of COVID-19 patients in October 2020. There are several case reports suggesting remdesivir causing bradyarrhythmia in COVID-19 patients. Objective: To increase the knowledge and awareness among healthcare professions (HCPs) about the risk of arrhythmias associated with the use of remdesivir. Methods: We used the FDA Adverse Events Reporting System (FAERS) database to find bradyarrhythmia as a reported adverse event (AE) due to remdesivir until October,2021. Total 6,504 events were reported, out of which 5,996 (92.2%) were reported by HCPs. These AEs were included and further analyzed. Results: Out of 5,996 AEs reported with remdesivir, total 537 (9.0%) events were bradyarrhythmia. There were 74 (1.27%) events reported for atrial fibrillation, and 24 (0.04%) for ventricular tachycardia attributed to the use of remdesivir. Reported events of bradyarrhythmia were further divided and analyzed into men vs women, and different age groups of years 18-64, 65-85, >85. Total events of bradyarrhythmia among men (238, 6.5%) vs women (141, 6.4%) were not significantly different. Among all the age groups, more events were reported in younger women in the age group of 18-64 (12.3%) vs 65-85 (7.9%) vs >85 (6.9%). Conclusion: Multiple studies have shown COVID-19 associated tachyarrhythmias, likely secondary to the myocardial damage due to hypoxia. Few studies have also suggested bradyarrhythmias in these patients. Our analysis of the FAERS database also showed many reported AEs of bradyarrhythmia attributed to the use of remdesivir. Postulated mechanisms include;medication side effects, damage to the SA node as a complication of the COVID-19 disease process, and electrolyte imbalance due to the renal failure. Close surveillance of these patients with early diagnosis can lead to prompt discontinuation of the medication, which can further decrease the mortality related to bradyarrhythmias. Further studies are required to identify the at-risk population and to better understand the risk of bradyarrhythmia associated with remdesivir.

18.
American Journal of Respiratory and Critical Care Medicine ; 205(1), 2022.
Article in English | EMBASE | ID: covidwho-1927746

ABSTRACT

With the spread of the novel coronavirus disease 2019 (COVID-19) pandemic, an alarming number of patients now present with acute respiratory distress syndrome (ARDS). Conservative fluid management with diuresis in the ARDS patients improves lung function and decreases ventilator-dependent days. Several cardiac manifestations have been reported in COVID-19 patients including rhythm disorders, myocarditis, Takotsubo cardiomyopathy and myocardial infarction. A 65-year-old Asian female with a history of hypertension presented to the emergency department with cough, worsening dyspnea and palpitations of one-week duration. Investigations at admission were significant for a positive COVID-19 polymerase chain reaction test with an electrocardiogram (EKG) (Figure 1 Panel-A) revealing inferior ST-elevations. Troponin-T was elevated to 1162 ng/L with bedside echocardiogram revealing inferior hypokinesis. Due to concerns for acute ST-elevation myocardial infarction (STEMI), the patient underwent cardiac catheterization with no obvious coronary artery occlusion. A ventriculogram revealed apical ballooning and the patient was treated for COVID-19 induced Takotsubo cardiomyopathy. The patient developed worsening respiratory distress on hospitalization day 3 requiring oxygen supplementation with a high-flow nasal cannula. Conservative fluid regimen and diuretic therapy were being administered when the patient developed ventricular fibrillation and suffered a cardiac arrest. After successful resuscitation, a repeat EKG (Figure 1 Panel-B) demonstrated new anterior and inferior ST-elevations. The patient required increasing vasopressor support, and a repeat cardiac catheterization to rule out coronary artery thromboembolism induced STEMI was negative. A right heart catheterization revealed elevated SVR with decreased cardiac index. The patient clinically deteriorated despite negative fluid balance with recurrent malignant arrhythmias. A bedside echocardiogram performed revealed persistent apical hypokinesis and systolic anterior motion of anterior mitral leaflet (Figure 1 Panel-C) with flow acceleration at left ventricular outflow tract (LVOT) (Figure 1 Panel-D). Due to concerns of cardiogenic shock secondary to Takotsubo cardiomyopathy with dynamic LVOT obstruction physiology, the patient was treated with liberal intravenous fluid resuscitation and successfully weaned from vasopressor therapy. Although she was successfully extubated 2 days later, the patient, unfortunately, passed away later from a thromboembolic stroke. Severe COVID-19 infections are associated with catecholamine surge which may precipitate Takotsubo cardiomyopathy in the susceptible patient population. Female patients with Takotsubo cardiomyopathy are at increased risk of developing dynamic LVOT obstruction. In these patients, management of shock and ARDS can be challenging as the use of inotropic agents may result in hemodynamic instability. Our patient was successfully hemodynamically stabilized using fluid resuscitation once the inotropic support was withdrawn after identifying dynamic LVOT obstruction.

19.
Journal of Paediatrics and Child Health ; 58(SUPPL 2):97-98, 2022.
Article in English | EMBASE | ID: covidwho-1916250

ABSTRACT

Background: COVID-19 trials took <1 year to identify therapies reducing death in >30,000 patients but the Australian Placental Transfusion Study took >12 years to show that delaying cord clamping reduced death or major disability (cerebral palsy, severe visual loss, deafness, or cognitive delay) in 1,531 preterm infants. What can this teach us? Further, as composite outcomes of death or major disability can be inconclusive if each is unequally affected (as in the NeOProM Collaboration1) 2 important aims are (i) global co-operation (https://www.alphacollaboration.com/) to identify core Participant-Intervention-Comparator-Outcome questions for trials assessing mortality, a key outcome, and (ii) to answer those questions in much larger, faster trials. Such trials will also yield much more precise estimates of disability in survivors than was previously typical - a major benefit. Method: To inform these aims we compared enrolment in 2 COVID-19 trials and in 10 trials by IMPACT collaborators with samples >1,500 in high- or low-or-middle-income countries (HIC/LMIC). Results: The COVID-19 trials took 3-9 months, enrolling 13 - 219 per-site-per-year. Perinatal trials took 16-86 months, enrolling 5 - 1,700 per site per year. Trials in pregnant women or LMIC (n = 53,092) enrolled 5 times more than trials in newborns or restricted to HIC (n = 9,014). (Table) Conclusions: Greater international collaboration could resolve questions of shared relevance and priority more rapidly. Megatrials addressing mortality may benefit from highly streamlined processes for enrolment and minimal data collection, e.g., RECOVERY's one-page outcome form.

20.
American Journal of Respiratory and Critical Care Medicine ; 205:2, 2022.
Article in English | English Web of Science | ID: covidwho-1881021
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