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Objectives: To evaluate how payers utilize Institute for Clinical and Economic Review (ICER) assessments to inform coverage or formulary decisions. Method(s): Double-blinded, web-based survey was fielded through Xcenda's research panel, the Managed Care Network, from June to July 2022. Result(s): A total of 51 payers from health plans (n=27), integrated delivery networks (n=12), and pharmacy benefit managers (n=12) participated in the survey. When assessing the usefulness of ICER's value assessment framework (VAF) to inform formulary decisions within their organizations, 57% of payers indicated it was extremely/very useful, 33% indicated somewhat useful, and 10% indicated not at all/not very useful. Most respondents (73%) agreed that ICER assessments are aligned with their organization's internal assessment. Utilization of ICER's VAF was most prevalent in high-cost drug or disease states (78%), rare/orphan disease states (71%), and oncology/hematology disease states (67%). Payers reported less use in primary care disease states (29%), COVID-19 (8%), and digital therapeutics (4%). In the last 24 months, 20% of payers reported ICER's recommendations often influenced coverage decisions, 59% indicated occasional influence, and 22% indicated no influence. In the last 24 months, payers indicated the top 5 ICER assessments that influenced their coverage decisions included high cholesterol (38%), Alzheimer's disease (36%), atopic dermatitis (33%), multiple myeloma (31%), and chemotherapy-induced neutropenia (28%). ICER assessments that were less impactful included beta thalassemia (3%), digital health technologies (3%), and supervised injection facilities (3%). Payers reported using ICER assessments to inform both expanded and restricted coverage decisions. Conclusion(s): Payers find ICER's VAF useful to inform their organization's formulary decisions. ICER's assessments often align with payers' internal assessments and are most frequently utilized for high-cost drugs or disease states. Payers indicate ICER assessments have affected both expansion and restriction in their coverage policies.Copyright © 2023
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Delivery of self-amplifying mRNA (SAM) has high potential for infectious disease vaccination due to its self-adjuvanting and dose-sparing properties. Yet a challenge is the susceptibility of SAM to degradation and the need for SAM to reach the cytosol fully intact to enable self-amplification. Lipid nanoparticles are successfully deployed at incredible speed for mRNA vaccination, but aspects such as cold storage, manufacturing, efficiency of delivery, and the therapeutic window can benefit from further improvement. To investigate alternatives to lipid nanoparticles, a class of >200 biodegradable end-capped lipophilic poly(beta-amino ester)s (PBAEs) that enable efficient delivery of SAM in vitro and in vivo as assessed by measuring expression of SAM encoding reporter proteins is developed. The ability of these polymers to deliver SAM intramuscularly in mice is evaluated, and a polymer-based formulation that yields up to 37-fold higher intramuscular (IM) expression of SAM compared to injected naked SAM is identified. Using the same nanoparticle formulation to deliver a SAM encoding rabies virus glycoprotein, the vaccine elicits superior immunogenicity compared to naked SAM delivery, leading to seroconversion in mice at low RNA injection doses. These biodegradable nanomaterials may be useful in the development of next-generation RNA vaccines for infectious diseases.Copyright © 2023 The Authors. Advanced Therapeutics published by Wiley-VCH GmbH.
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This study aims to study the clinical-laboratory peculiarities of the coronavirus disease (COVID-19) course in patients with type 2 diabetes mellitus (DM). There were examined 60 patients with the coronavirus disease COVID-19. Patients were divided into two groups: group I - 30 patients with the coronavirus disease (COVID-19) with concomitant type 2 diabetes mellitus;group II - 30 patients with coronavirus disease (COVID-19) without diabetes mellitus;control group - 20 people. There were studied peculiarities of clinical-laboratory changes in patients with coronavirus disease with type 2 diabetes mellitus. General clinical laboratory tests, determination of biochemical parameters, coagulogram, ferritin, CRP, procalcitonin, D-dimer and endothelin-1 were performed. Blood saturation was measured. Out of the instrumental methods, an ultrasound examination of the lungs and RTG of thoracic organs was performed. Patients were admitted on the 5.46+/-0.87 day of the disease. The length of the hospital stay for patients of group I was 19.9+/-1.66 bed days and 14.7+/-0.91 bed days for the patients of group II. A severe course of the disease was observed in 83.3% of patients of group I and 33.3% of group II;a moderate severity course was observed in 16.7% of patients with concomitant DM and 66.7% of patients without concomitant DM. Respiratory failure (RF) of 1 degree was observed in 30% of patients of group 1, RF of the 2 degree - in 16.7% of patients, and RF of the 3 degree - in 10% of patients. In patients without DM, RF of 1 degree - was in 30% of patients, and RF of the 2 degree - was in 13.3% of patients. The laboratory diagnostic methods determined that the levels of leukocytes, D-dimer, endothelin-1, IL-6, procalcitonin, and ferritin were higher in patients with concomitant type 2 DM. In patients with type 2 DM, the course of the coronavirus disease is more severe and longer, with the development of pneumonia and respiratory failure. It is accompanied by leukocytosis, lymphopenia, increased ESR, prothrombin index, IL-6, CRP level, procalcitonin and endothelin-1. Copyright © 2023 The Authors.
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The pandemic took its toll on memory clinics with many forced to close or scale back their services. This led to lengthening waits for dementia assessment and left many without a diagnosis.
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The aim of the research. To conduct a cluster analysis of the assessment profile of students who participated in work of medical organisations providing care to COVID-19 patients to develop recommendations for its correction. Material and methods. The study was carried out at the premises of Prof. V.F. Voino-Yasenetsky Krasnoyarsk State Medical University (KrasSMU). The study group was constituted by 66 students in 3-6 years of study of the Medical and the Paediatric faculties of the University who took part in activities of medical organisations providing healthcare to patients with COVID-19. The items were presented in the form of binary questions and ranking scales. The analysis of qualitative attributes was carried out in the form of relative values with calculation of the standard error of the proportion. For ranking and nonparametric quantitative characteristics, the mode, median, centiles (Me [P25;P75]) and other nonparametric criteria for comparative statistics and communication statistics were used. For segmentation of respondents according to some criteria, depending on the answers, the method "two-step cluster analysis" and the method of "decision tree" were used. Results. The results of the study indicate a high motivational component related to practical medical activity of medical students during the difficult epidemiological situation since 94.1% of the respondents declared the readiness to support practical healthcare. Almost half of the surveyed 47.0% of students included in cluster 2, in contrast to students of clusters 1 and 3, are characterised by a high opinion on the degree of their contribution to the struggle against the COVID-19 epidemic and a high level of knowledge and skills, rating themselves at about 9.0 points out of 10 possible. In addition, the results of the study indicate an association between the level of students' self-esteem in regard to their contribution to the fight against COVID-19 with the level of the students' self-esteem of knowledge and skills and the duration of work in a medical organisation. Conclusion. The analysis performed has made it possible to formulate guidelines for support of medical students' professional attitudes within the framework of practice-oriented education, including distance learning.Copyright © 2021, Krasnoyarsk State Medical University. All rights reserved.
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Coronavirus disease 2019 (COVID-19) is a fatal pandemic viral disease caused by the severe acute respiratory syndrome corona virus type-2 (SARS-CoV-2). The aim of this study is to observe the associations of IL-6, SARS-COV-2 viral load (RNAemia), IL- 6 gene polymorphism and lymphocytes and monocytes in peripheral blood with disease severity in COVID-19 patients. This study was carried out from March 2021 to January 2022. RT-PCR positive 84 COVID-19 patients and 28 healthy subjects were enrolled. Blood was collected to detect SARS-COV-2 viral RNA (RNAemia) by rRT-PCR, serum IL-6 level by chemiluminescence method, SNPs of IL-6 by SSP-PCR, immunophenotyping of lymphocytes and monocyte by flow cytometry. Serum IL-6 level (pg/ml) was considerably high among critical patients (102.02 +/- 149.7) compared to severe (67.20 +/- 129.5) and moderate patients (47.04 +/- 106.5) and healthy controls (3.5 +/- 1.8). Serum SARS-CoV-2 nucleic acid positive cases detected mostly in critical patients (39.28%) and was correlated with extremely high IL-6 level and high mortality (R =.912, P < 0.001). Correlation between IL-6 and monocyte was statistically significant with disease severity (severe group, p < 0.001, and 0.867*** and critical group p < 0.001 and 0.887***). In healthy controls, moderate, severe and critically ill COVID-19 patients, IL-6 174G/C (rs 1800795) GG genotype was 82.14%, 89.20%, 67.85% and 53.57% respectively. CC and GC genotype had strong association with severity of COVID-19 when compared with GG genotype. Significant statistical difference found in genotypes between critical and moderate groups (p < 0.001, OR-10.316, CI-3.22-23.86), where CC genotype was associated with COVID-19 severity and mortality. The absolute count of T cell, B cell, NK cell, CD4+ T cells and CD8+ T cells were significantly decreased in critical group compared to healthy, moderate and severe group (P < 0.001). Exhaustion marker CD94/NKG2A was increased on NK cells and CD8+ cytotoxic T cell among critical and severe group. Absolute count of monocyte was significantly increased in critical group (P < 0.001). Serum IL-6, IL-6 174 G/C gene and SARS-CoV-2 RNAaemia can be used in clinical practice for risk assessment;T cell subsets and monocyte as biomarkers for monitoring COVID-19 severity. Monoclonal antibody targeting IL-6 receptor and NKG2A for therapeutics may prevent disease progression and decrease morbidity and mortality.Copyright © 2023 Elsevier Inc.
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Background: Gastrointestinal bleeding is one of the consequences of COVID-19, which is associated with increased hospitalization and patient mortality. This study was conducted to determine the prevalence of endoscopic findings and the outcome of gastrointestinal bleeding in patients with COVID-19 who were hospitalized from September to December 2019 in Al-Zahra Hospital, Isfahan. Method(s): In this cross-sectional study, out of 5800 patients who were admitted to Al-Zahra Hospital in Isfahan from September to December 2019 due to COVID-19 (according to the positive PCR test result), 87 patients who underwent endoscopy due to upper gastrointestinal bleeding by a skilled gastroenterologist, were selected and studied. Demographic characteristics, underlying diseases, use of anticoagulants, and laboratory findings were studied and evaluated and finally, the disease was evaluated and compared based on endoscopic findings. Result(s): Based on the results obtained from this research, the patients with endoscopic lesions had higher average age (P=0.041), lower blood oxygen saturation percentage (P=0.028), and higher bleeding intensity (P=0.018). The frequency of using anticoagulant drugs in the group whose endoscopy results were abnormal was higher but insignificant. Hemoglobin, platelet, lymphocyte, and CRP levels were higher in the group whose endoscopy was normal, and NLR, LDH, and D-dimer levels were higher in the group whose endoscopy was abnormal (P<0.050). Three people (11.55%) from the group with normal endoscopy and 18 people (29.5%) from the group with abnormal endoscopy died, but the frequency of death was not significantly different between the two groups (P=0.070). Conclusion(s): The findings of the present study showed that the COVID patients with upper gastrointestinal bleeding who had endoscopic lesions had significant differences in some characteristics such as age, bleeding intensity, and blood oxygen saturation percentage with patients with normal endoscopy. Also, the frequency of death in patients with endoscopic lesions was relatively higher. Therefore, COVID patients with gastrointestinal bleeding should undergo endoscopy as soon as possible and necessary measures should be taken to control and prevent gastrointestinal bleeding.Copyright © 2022 Tabesh et al. Tehran University of Medical Sciences. Published by Tehran University of Medical Sciences.
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Background: People living with cancer are reported to be at increased risk of hospitalization and death following infection with acute respiratory syndrome coronavirus 2 (SARS-CoV-2). This is proposed to be dependent on a combination of intrinsic patient and cancer factors such as cancer subtype, and emerging SARS-CoV-2 variants with differing pathogenicity. However, COVID-19 phenotype evolution across the pandemic from 2020 has not yet been systematically evaluated in cancer patients. Method(s): This study is a population-scale real-world evaluation of Coronavirus outcomes in the United Kingdom for cancer patients from 1st November 2020-31st August 2022. The cancer cohort comprises individuals from Public Health England's national cancer dataset, excluding individuals less than 18 years old. Case-outcome rates, including hospitalization, intensive care and casefatality rates were used to assess the evolution in disease phenotype of COVID-19 in cancer patients. Multivariable logistic regression models were fitted to compare risk of Coronavirus outcomes in the cancer cohort relative to the non-cancer population during the Omicron wave in 2022. Result(s): The cancer cohort comprised of 198,819 positive SARS-CoV-2 tests from 127,322 individual infections. Coronavirus case-outcome rates were evaluated by reference to 18,188,573 positive tests from 15,801,004 individual infections in the non-cancer population. From 2020 to 2022, the SARS-CoV-2 disease phenotype became less severe in both patients with cancer and the non-cancer population, though cancer patients remain at higher risk. In 2022, the relative risk of Coronavirus hospital admission, inpatient hospitalization, intensive care admission and mortality in cancer patients was 3.02x, 2.10x, 2.53x and 2.54x compared to the non-cancer population following multivariable adjustment, respectively. Higher risk of hospital admission and inpatient hospitalization were associated with receipt of B/T cell antibody and/or targeted therapy which also corresponded with an increased risk of Coronavirus mortality. Conclusion(s): The disease phenotype of SARS-CoV-2 in cancer patients in 2022 has evolved significantly from the disease phenotype in 2020. Direct effects of the virus in terms of SARS-CoV-2 hospitalization, intensive care and case fatality rates have fallen significantly over time. However, relative to the general population, people living with cancer and hematological malignancies remain at elevated risk. In order to mitigate the indirect effects of the SARS-CoV-2 pandemic in terms of disruption to cancer care, there should be increased focus on preventative measures. Used in conjunction with vaccination and early treatment programs, this will maximize quality of life for those with cancer during the ongoing pandemic and ensure the best cancer outcomes.
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The number of people with long-term consequences of COVID-19 is increasing worldwide. The long-term prognosis for patients remains poorly understood. Objective. To study cardiometabolic and psychocognitive features in comorbid elderly patients with atrial fibrillation (AF), de-pending on the presence of post-COVID syndrome (PCS). Material and methods. The observational analytical cohort study included 223 patients with AF and comorbidity (coronary artery disease, hypertension, obesity, type 2 diabetes mellitus) aged 60-74, who were divided into two groups: group 1 included 123 patients without COVID-19 and group 2 included 110 patients with a history of COVID-19 and the presence of PCS. The study evaluated laboratory and instrumental tests, and a general clinical study assessing psychocognitive disorders using the SPMSQ and HADS questionnaires was conducted. Results and discussion. In COVID-19 survivors, compared with patients of group 1, there were more pronounced atherogenic changes in total cholesterol (TC) (p=0.003), low-density lipoprotein cholesterol (p<0.001), and triglycerides (p=0.011). Lower dia-stolic blood pressure was found in COVID-19 survivors (p<0.001). In addition, patients in group 2 had higher median pulse pressure (p<0.001) and heart rate (p<0.001). In group 2 patients, a larger ascending aorta diameter was observed (p<0.001). The anx-iety-depressive syndrome was more common in COVID-19 survivors with comorbidities, and a statistically significant difference was found in clinical anxiety (24%, p=0.041) and subclinical depression (21%, p=0.015). When assessing cognitive function, mod-erate cognitive impairment was detected in 22% (p=0.005) of patients with PCS and severe cognitive impairment in 2% (p=0.007). Conclusion. In comorbid elderly patients with the post-COVID syndrome, a high prevalence of psychocognitive disorders and adverse cardiometabolic changes were observed, supporting the need for long-term monitoring of the general clinical condition and psychocognitive status of COVID-19 survivors.Copyright © 2023, Media Sphera Publishing Group. All rights reserved.
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UK obstetric sonographers adapted their working practices during the COVID-19 pandemic in response to new guidance issued by professional organisations, and requirements for on-going departmental risk assessments. This study aimed to provide an insight into the implementation of this guidance, completion of risk assessments and perception of support within UK obstetric ultrasound departments during the pandemic period. Obstetric sonographers working in the UK (n=138) used the Qualtrics XMTM platform to complete an anonymous, online, cross-sectional survey about their working experiences during the pandemic. Participants responded to closed questions about national guidance, risk assessments and their perception of support whilst providing fetal ultrasound screening services. Respondents provided additional detail about their experiences in these areas via free-text boxes. Over 90% of respondents were aware of, or had read guidance issued by professional organisations, although sonographers rated the overall usefulness of new guidelines at an average of 5.2/10 (where 0 = not useful at all, and 10 = extremely useful). Challenges for the implementation of guidance in departments were also identified, mostly related to the clinical working environment, including limitations of physical space (76.3%), time constraints (67.5%) and ventilation (61.3%). Most sonographers (77.2%) were aware that a departmental risk assessment had been undertaken, with waiting areas, scan rooms and clinically vulnerable staff highlighted as the most concerning factors. Sonographers felt most supported by their ultrasound colleagues (83.5%) and line managers (41.2%). They felt least supported by senior management and leadership personnel (60.8%), other antenatal colleagues (51.5%) and professional organisations (41.2%). Whilst most sonographers were aware of published COVID-19 guidance, challenges for its implementation in clinical departments were identified. Local risk mitigation strategies often did not prioritise the scan room environment, despite it being highlighted as a concern. Support from the wider, senior service team and professional organisations will be essential to facilitate post-pandemic recovery of the workforce.
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About 10 % of all symptomatic COVID-19 patients suffer from long-lasting health complaints. Fatigue, cognitive and emotional disorders are the most frequent neuropsychiatric symptoms. Evidence-based therapies for these post-covid impairments are still lacking. Here, we examined the feasibility of a newly developed group-therapy program for patients with fatigue, emotional and cognitive disorders following COVID-19. 24 patients with ICD-10 diagnosis of F06.8 and U0.09 participated in the group therapy on average 13 month after their acute COVID-19 infection. Before and after the group therapy they underwent a comprehensive clinical and neuropsychological assessment. The group therapy was held online and consisted of 8 weekly sessions with psychotherapeutic and psychoeducational elements regarding fatigue and pacing, mindfulness, psychiatric disorders, cognition as well as physical activity after COVID-19. Participation in the group was high with an average of 7.25 of 8 visited sessions. Mean overall group satisfaction was 7.78 out of 10 points. Patients improved in their self-reported fatigue, daily living skills, depression and subjective cognitive abilities as well as in their objective performance in neuropsychological tests of attention during the study time. The newly developed group therapy program for patients with fatigue and emotional and cognitive disorders following an infection with SARS-CoV-2 was well accepted and evaluated and is feasible in an online setting. Copyright © 2023. Thieme. All rights reserved.
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Background: Sickle cell disease (SCD) is one of the most common single gene disorders worldwide and is characterised by significant morbidity and early mortality.[1] Pregnancy in SCD is associated with an increased risk of maternal and foetal complications.[2,3] The 2011 RCOG and the 2021 BSH guidelines[5,6] on the management of pregnancy in SCD have provided the basis for best practice care in the UK over the past decade and is the guidance which we follow in Ireland. To date, there is no published data on outcomes for pregnant women with SCD in Ireland. The number of Irish patients with SCD has risen over the past 20 years. Without a national database, the exact prevalence is not known but currently there are at least 600 adults and children with SCD in Ireland, whose population is just over 5 million.[4] Aims: Our study assesses outcomes of pregnant patients with SCD from 2015 to 2022. Our aims were to: * Assess adherence to current guidelines * Assess pregnancy outcomes and maternal complications * Assess transfusion rates amongst our patient cohort. Method(s): This is a retrospective cohort study. We do not have a directly matched cohort, but have compared our findings to published data on Irish pregnancy outcomes from the Irish Maternity Indicator System National Report and have correlated our findings with studies of women with SCD who were managed in UK centres.[8,9,10] Results: We reviewed outcomes of 29 pregnancies in 19 women over a 7-year period. The median age was 29 (range 20-41) and the predominant maternal sickle genotype was HbSS (65.5%). Before conception, 55.2% of cases had pre-existing complications of SCD, including acute chest syndrome (ACS), pulmonary hypertension (PHTN) and prior stroke. In accordance with current guidelines, 100% of women (n=29) were prescribed folic acid, penicillin, and aspirin prophylaxis. 51.7% (n=15) of women had documented maternal complications during pregnancy, including ACS (34%), vaso-occlusive crisis (34%), gestational diabetes (10%), VTE (3%) and UTI (3%). Two women (7%) developed Covid-19 pneumonitis despite vaccination. There was one case of maternal bacteraemia (3%). 65.5% of cases (n=19) required blood transfusion during pregnancy. One woman was already on a blood transfusion programme for disease modification prior to pregnancy. In 6 cases (20.6%), a transfusion programme was commenced during pregnancy due to prior pregnancy complications or intrauterine growth restriction. During pregnancy, 27.6% (n=8) of women required emergency red cell exchange for ACS. Prior studies have suggested that between 30% and 70% of pregnant women with SCD require at least one blood transfusion during pregnancy.[8,9,10] By comparison, only 2.6% of the Irish general obstetric population required transfusion during pregnancy.[7] 20.6% (n=6) of births were preterm at <37 weeks' gestation. There was one live preterm birth (3%) at <34 weeks and one intrauterine death (3%) at 23 weeks' gestation. Similar to UK data[9], 31% of women required critical care stay (n=9) during pregnancy, in comparison with 1.44% nationwide in 2020.[7] Conclusion(s): It is well established that pregnancy in SCD is high risk, and despite adherence to current guidelines, we have shown very high rates of critical care admission, significant transfusion requirement and hospital admissions. Our findings are comparable to published UK outcomes and they further support the need for a comprehensive specialist care setting for this patient cohort.
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The novel coronavirus SARS-CoV-2 is associated with a significant incidence of neuropsychiatric disorders, which tend to have a long course in the post-COVID period. Objective(s): to study post-COVID mental disorders in clinical psychiatric practice. Patients and methods. 30 patients aged 37.75+/-14.07 years with anamnesis of SARS-CoV-2 infection were examined. Clinical scale assessment was carried out using the Hamilton Depression and Anxiety Scale. The Symptom-Checklist (SCL-90-R) was used to assess the psychopathological status of the patient. Patients' cognitive functioning was assessed using the Mini-Cog Cognitive Assessment Questionnaire. Patients' sleep quality was assessed by the Pittsburgh Sleep Quality Index (PSQI). Results and discussion. Mental disorders associated with a previous coronavirus infection are observed in a wide time range from less than 1 month to a year after the previous disease, and in no case did the coronavirus infection have a severe course. Sleep disorders, anxiety and depressive disorders, which did not exceed a moderate degree of severity, and asthenia dominated in the structure of the post-COVID syndrome. The level of mental distress in patients with post-COVID syndrome increased 2 times. Post-COVID mental disorders are interrelated with female gender, age, and psychotraumatic factors associated with the pandemic. Cognitive impairment mediated by mental disorders was observed in approximately 60% of patients and did not reach the degree of dementia. Conclusion. The clinical picture of the post-COVID syndrome is represented by a wide range of mental disorders, the development of which involves not only biological, but also psychosocial factors associated with the COVID-19 pandemic, which determines the specifics of diagnostic approaches and the feasibility of complex treatment of the post-COVID syndrome.Copyright © 2022 Ima-Press Publishing House. All rights reserved.
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Timely, effective, and safe antiviral therapy in COVID-19 patients reduces complications, disability and mortality rates. The greatest concern with remdesivir is the risk of drug-induced liver injury, including in patients whose liver function is compromised by COVID-19. The aim of the study was to investigate the efficacy and safety of remdesivir in patients with confirmed SARSCoV-2 infection who had been admitted to an infectious diseases hospital in the Volgograd region in March 2022. Material(s) and Method(s): the authors carried out an open, non-randomised, single-arm study using medical records of 234 patients who had been diagnosed with "U07.1 COVID-19, virus identified" and prescribed remdesivir upon admission. The effectiveness of therapy was evaluated using two criteria: the need for oxygen supplementation or ventilatory support, or mortality. The authors conducted the evaluation on days 7, 14, and 28 using the six-point ordinal severity scale by Y. Wang et al. The safety of therapy was assessed on the basis of complaints and changes in laboratory findings. Result(s): for the patients prescribed remdesivir at admission, the 7-day mortality rate was 3.0%, the 14-day mortality rate was 5.6%, and the 28-day mortality rate was 7.3%. With the exception of a patient with myocardial infarction, all the patients who had been hospitalised with mild COVID-19 and prescribed remdesivir did not require oxygen therapy and/or transfer to intensive care and were discharged following recovery. The patients with moderate to severe COVID-19 had the 14-day mortality rate of 6.4% and the 28-day mortality rate of 8.6%. 17 patients (7.2%) discontinued remdesivir prematurely for various reasons, including adverse drug reactions. Remdesivir therapy of 5-10 days was associated with an increase in ALT activity by 2.7 +/- 0.8 times in 15.9% of patients with mild COVID-19, by 3.8 +/- 1.8 times in 20.4% of patients with moderately severe COVID-19, and by 4.8 +/- 2.7 times in 24% (12/50) of patients with severe COVID-19. In two patients (0.9%), the increase exceeded 10-fold the upper limit of normal. Conclusion(s): the obtained results support recommending remdesivir to patients with mild, moderate and severe COVID-19, including those with moderately elevated baseline activity of hepatic transaminases.Copyright © NEICON ISP LLC. All rights reserved.
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The most common non-Hodgkin's lymphoma (NHL) is diffuse large B-cell lymphoma (DLBCL), an aggressive lymphoma that can be cured with standard frontline chemo-immunotherapy in 60%-70% of patients but with historically poor outcomes for relapsed/refractory disease. Patients with relapsed DLBCL after autologous stem cell transplant (ASCT) or with chemotherapy-refractory disease have a particularly dismal prognosis, with a median overall survival (OS) of only 6 months. Chimeric antigen receptor (CAR) T-cell therapy has significantly improved outcomes for patients with relapsed/refractory large B-cell lymphoma, mantle cell lymphoma and follicular lymphoma, with multiple FDA approved CAR T products now commercially available in many developed world including European countries. Ongoing studies seek to move CAR T cells to earlier lines of therapy and to characterise the efficacy and safety of CAR T-cell approaches in additional lymphoma histologies including relapsed/refractory follicular lymphoma and chronic lymphocytic leukaemias. Other areas of active research address CAR T in combination with other lymphoma-directed therapies, and mechanisms of CAR T resistance. We conducted a retrospective observational study assessing the outcomes of patients referred to our tertiary centre, University College London hospital NHS foundation Trust (UCLH) from January 2018 to December 2022, over a 48-month period. We collected data including patients' demographics, types of lymphomas, prior lines of therapies including stem cell transplantation, bridging therapies as appropriate, complications and overall response rate. We also analysed the communication between teams during the challenging period of the COVID-19 pandemic.
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Introduction: Prior to the COVID-19 pandemic an estimated 5000 surgical and 12000 percutaneous tracheostomies were completed in the UK each year.1 A UK study looking at COVID-19 tracheostomy outcomes found 1605 tracheostomy cases from 126 hospital, median time from intubation to tracheostomy was 15 days while 285 (18%) patients died following the procedure.2 COVID-19 patients also typically spend longer in critical care with prolonged time receiving organ support when compared to patients diagnosed with other viral pneumonias.3 Incidence of laryngeal pathologies are also higher in COVID-19 patients post tracheostomy.4 Objectives: The aim of this observational study was to review the outcomes of patients post tracheostomy insertion during the COVID-19 pandemic compared to non-COVID patients. Method(s): A service evaluation was completed including all patients requiring a tracheostomy since the beginning of the COVID-19 pandemic in March 2020 within University Hospital Wales, Cardiff. Data was captured from local tracheostomy databases. Patients were grouped into either COVID or non-COVID based on their clinical history. The key outcomes evaluated were number of tracheostomies, average time to cuff deflation and decannulation, critical care and hospital length of stay, occurrence of adverse events and time from critical care admission to tracheostomy insertion. Data was evaluated using descriptive statistics using Microsoft ExcelTM. Result(s): During the review period 58 patients with COVID-19 and 158 without required a tracheostomy. In the COVID-19 group cuff deflation occurred at a median of 10 days post insertion compared to 7 days. Decannulation occurred at a median of 16 days in patients with COVID-19 compared to 18 days. The rate of decannulation was also higher in the COVID-19 group at 74.1% compared to 67.1%. Critical care length of stay was 37 days in the COVID-19 compared to 25 days. Time from intubation to tracheostomy was comparable between groups at a median of 16 days for our COVID-19 cohort compared to 15 days. The incidence of clinical incidents was higher in the non-COVID-19 group at 10.1% compared to 5.2%. Conclusion(s): This internal service evaluation has shown that COVID-19 patients typically spend longer in critical care but their time to decannulation was shorter and their rate of decannulation was higher in our cohort then in the comparison group. This could be due to the tertiary neuroscience and major trauma specialities within our Health Board. Both with groups of patients that, due to the nature of their injuries may require prolonged periods of tracheostomy insertion even after critical care discharge.
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HbA1c measurement is widely used for diagnosis/ management/remission of diabetes with international schemes certifying comparability. A) 75 year-old Chinese female with type 2 diabetes was admitted in April 2020 with Covid-19 and diabetic ketoacidosis. Glucose was 35mmol/l and HbA1c 150mmol/mol with previous HbA1c of 45mmol/mol on metformin and alogliptin. She was treated for ketoacidosis and once-daily Lantus introduced along with supportive management of viral illness. B) 68 year-old Afro-Caribbean with type 2 diabetes on metformin before admission, presented with new onset, jerky ballistic movements of high amplitude in right arm, 10-15 movements every 5 min. Admission glucose was >33mmol/l, ketones 1.8mmol/l and HbA1c >217mmol/ mol. Hemichorea-hemiballism, a hyperglycaemia related movement was diagnosed and insulin commenced. Glucose decreased to 8-20mmol/ l, reaching 5-15mmol/ l by time of discharge. Ballistic movements resolved when glycaemic control improved with HbA1c 169mmol/mol, 25 days after discharge. C) Several days before admission, a female with diabetes over 20 years required attention from paramedics on four occasions for hypoglycaemia. Months beforehand metformin was replaced by gliclazide due to chronic kidney disease with HbA1c 50mmol/mol, and she was transfused six weeks before admission for microcytic anaemia. Gliclazide was discontinued and her diet modified which prevented further hypoglycaemic episodes. Variant haemoglobin, beta-thalassaemia which can overestimate glycaemia;undetected by HbA1c HPLC method, invalidated HbA1c as did the blood transfusion. These cases highlight that inadequate understanding of HbA1c can lead to acute presentations of dysglycaemia. As HbA1c accuracy can be affected by multiple factors, clinical assessment and triangulation are key to the management of such patients.
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Introduction: de Quervain's syndrome is a painful condition commonly presented to hand therapists. Exercise is utilised as an intervention, but isometric exercise has not been investigated. We aimed to assess the feasibility and safety of isometric thumb extension exercise for de Quervain's syndrome and to explore differences between high-load and low-load isometric exercise. Method(s): This parallel-group randomised clinical feasibility trial included individuals with de Quervain's syndrome. All participants underwent a 2 week washout period where they received an orthosis, education, and range of motion exercises. Eligible participants were then randomised to receive high or low-load isometric thumb extension exercises, performed daily for 4 weeks. Feasibility and safety were assessed by recruitment and drop-out rates, adherence, adverse events, and participant feedback via semi-structured interviews. Secondary outcomes included patient-reported outcomes for pain and function, and blinded assessment of range of motion and strength. Result(s): Twenty-eight participants were randomised. There were no drop-outs after randomisation, and no serious adverse events. Adherence to exercise was 86.7%, with 84% of participants stating they would choose to participate again. There were clinically and statistically significant improvements in pain and function over time (p < 0.001) but not in range of motion or strength. There were no statistically significant between-group differences. Conclusion(s): Isometric thumb extension exercise within a multimodal approach appears a safe and feasible intervention for people with de Quervain's syndrome. A large multi-centre trial would be required to compare high- and low-load isometric exercises. Further research investigating exercise and multimodal interventions in this population is warranted.Copyright © The Author(s) 2023.
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Despite the low incidence, low mortality and relatively mild symptoms of COVID-19 in children, there has been a rise in pediatric patients who develop a condition resembling Kawasaki disease after COVID-19 or contact with individuals infected with SARS-CoV-2. This condition is known as the pediatric inflammatory multisystem syndrome temporally associated with SARS-CoV-2 infection (PIMS-TS). This review introduces the reader to the hypotheses of PIMS-TS pathogenesis, provides information about its diagnosis and treatment, presents clinical and laboratory data and describes treatments strategies used in children and adolescents hospitalized to the intensive care unit of the Pediatric Research and Clinical Center for Infectious Diseases. Besides, the review outlines the main diagnostic and prognostic challenges of PIMS-TS.Copyright © Extreme Medicine.All right reserved.
ABSTRACT
Introduction: The use of telemedicine in surgical care quickly increased due to the COVID-19 pandemic. However, uptake among surgical specialties has not been consistent. We aimed to characterize surgical provider perceptions of barriers and facilitators to telemedicine use. Method(s): Surgeons and nurses within the gastrointestinal surgery division at a high-volume, tertiary care academic center were contacted for participation in this study. Individual semi-structured interviews explored barriers and facilitators to telemedicine use. Qualitative analysis was conducted by multiple coders using NVivo12 software. Result(s): Six surgeons and three nurses participated in this study. Among the 9 participants, 44% identified as female and 33% were over age 50. Three themes were identified as facilitators to provider utilization of telemedicine: increased accessibility for rural patients due to decreased travel time and cost, enhanced provider productivity from reduced transition time between visits, and the ability of video telemedicine to facilitate non-verbal communication and visual examination. Three themes were identified as barriers to provider utilization of telemedicine: unreliable broadband connection, negative impacts on workflow due to scheduling challenges and insufficient IT support, and the inability to conduct a physical exam and immediately manage certain complications. Conclusion(s): As telemedicine becomes highly integrated into routine care, best practice guidelines to surgeon-patient telemedicine encounters should be established. This will improve virtual communication and consistency across providers, as well as provider satisfaction with telemedicine. Future interventions should address concerns with workflow logistics and technical support by developing comprehensive training and troubleshooting strategies for healthcare providers.