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Background: To assess the efficacy of various anticoagulants being prescribed in the COVID 19 induced hypercoagulability, so as to know optimally effective anticoagulant. Methods: This was a Indian observational study conducted in our covid centre at vijayawada,Andhra Pradesh between june 2020 to January 2021 . Results: A total of 100 COVID 19 subjects were included. The patients were found to be matched with respect to age, gender, diet and past history of various illnesses. Gender wise more males (60 patients)are affected when compared to females(40 patients). Age group more affected are less than or equal to 50yrs . Comorbidites like Diabetes(67patients),cardiac problems(62patients), dyslipidemia(62patients) were seen. Risk factors like smoking(52patients), alcoholism(50patients) noticed. Almost all subjects are RTPCR positive. IL- 6,CRP,LDH high in most subjects. Ferritin and PT/INR are normal in more subjects. Out of 100 patients oxygen is required in 48 subjects and BIPAP/CPAP required in 26 subjects. Death occurred in 24 patients (2 with CVA,22 with myocardial infraction). Mortality rate is more in vegetarians. More patients in our study belongs to CORADS score 4 and 5. D-dimer are increased in 67subjects. IL-6 are increased in 68patients . Frequency of subjects with raised D-dimer (p = 0.049) and CRP (p = 0.002) levels were found to be benefitted on receiving nattokinase. However, no other parameters such as IL-6 (p = 0.068) ferritin (p = 0.396), ESR (p = 0.278), PT/INR (p = 0.47) LDH (p = 0.34) or CORADS staging achieved such significant association. Also need of interventions such as Oxygen (p = 0.001), BIPAP/CPAP (p < 0.0001) were low in patients on nattokinase. No significant difference was noted in follow up investigations such as PT/INR (p = 0.31) and other markers (D-dimer, IL-6, LDH, CRP) (p = 0.55). No bleeding episodes were reported in subjects on nattokinase. Significant low rate of death was found in subjects who received nattokinase (p < 0.0001) and rivaroxaban (p < 0.0001). Also, significantly higher mortality rate was observed in subjects who required to be put on oxygen (p < 0.0001) as well as BIPAP/CPAP (p < 0.0001). Conclusions: Nattokinase simultaneously effects several key favourable benefits for thrombosis, hypertension, atherosclerosis, hyperlipidaemia, platelet aggregation, and neuroprotection in patients with COVID 19 infection. (Figure Presented).
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The COVID-19 virus has caused a global emergency and has attracted the attention of healthcare professionals and the public around the world. The significant increase in the number of new cases of infection with this virus demonstrates the relevance of the search for drugs that are effective against this pathogen. The aim of this work was to evaluate the antiviral efficacy of Mefloquin® against COVID-19. The antiviral efficacy of Mefloquin® against the new pandemic virus SARS-CoV-2 was studied in in vitro experiments in Vero C1008 cell culture and in vivo on Syrian golden hamsters. The results of the study revealed that the drug Mefloquine® at a concentration of 2.0 µg ml-1, when applied after infection of cells, suppresses the reproduction of the SARS-CoV-2 virus by 1.7-1.9 lg, the inhibition rate is about 99%. When using Mefloquine, pathological changes in the lung tissue were less pronounced than in the control group. 6 days after infection, it was shown that when using Mefloquine, there was a statistically significant decrease in viral load in the lungs of infected Syrian golden hamsters, with an inhibition rate of 95.5%.
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The post-COVID-19 recovery period is characterized by persistence of some symptoms, with immunological alterations being of great importance. Development of preventive measures to normalize mucosal immunity after a coronavirus infection determines the relevance of the current study. The aim was to study dynamics of clinical symptoms and level of secretory immunoglobulin A in individuals after a novel coronavirus infection as well as evaluate effectiveness of using IFNα-2b. Materials and methods. A study was conducted with patients aged 18 to 60 years old (n = 130), surveyed 1 to 9 months after post-infection, as well as in apparently healthy individuals lacking COVID-19 (n = 15). Previous novel coronavirus infection and post-COVID manifestations were verified based on medical documentation, complaints, anamnesis data, physical examination and questionnaires. The concentration of salivatory and nasopharyngeal mucosal sIgA was measured dynamically prior to and after administration of local therapy with IFNα-2b (gel applied intranasally twice a day for 30 days). Results. The acute period of COVID-19 was characterized by fever, anosmia, severe asthenia (fatigue and weakness), muscle and joint pain. Among the post-COVID manifestations at early period (1–3 months), pain in the joints and muscles (75.0%) as well as elevated body temperature (21.2%) were reliably detected, whereas in the long period (6–9 months) there were revealed dominance with the same frequency of shortness of breath, muscle and joint pain (75.8%, respectively). Based on examination data in healthy subjects, there was determined an arbitrary normal range of secretory IgA in saliva — 6.45±1.81 mg/ml and nasal swabs — 13.43±3.24 mg/ml. In the group of patients 1–3 months post-infection, therapy with IFNα-2b one month later resulted in significantly increased level of secretory IgA in saliva (from 1.84±0.28 to 5.78±1.96 mg/ml) and in nasal swabs (from 28.61±3.0 to 39.83±3.85 mg/ml) by more than 3- and 1.5-fold, respectively. In the group of patients without therapy was featured with stably sustained decline in sIgA level up to 9 months after COVID-19. In particular, the level of saliva sIgA ranged from 2.36±0.56 down to 2.16±0.66 mg/ml, and in nasal smears — from 15.66±1.32 to 10.23±1.07 mg/ml that differed insignificantly compared to baseline level. The rate of respiratory diseases prevailed in this group (27.6% of cases), which fully lacked in the group of topically administered IFNα-2b. Conclusion. In the post-COVID period, multiple organ disorders persist and reduced sIgA level is registered. Intranasally applied IFNα-2b made possible to normalize sIgA level and prevent accumulation of respiratory infectious pathologies.
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Introduction: In patients presented with hypertensive crises, a fundoscopic assessment is necessary because once hypertensive retinopathy is discovered, a hypertensive emergency is diagnosed, and intravenous antihypertensive medication is recommended. However, direct ophthalmoscopy is relatively underutilized, especially under the social distance regulation, which may result in delayed diagnosis and treatment. The novel method, namely, smartphone-based fundoscopy offers longer working distance and shorter doctor-patient contact time, however, there is limited data regarding its feasibility and effectiveness. Objective: We aimed to gather scientific evidence on the smartphone-based fundoscopy in terms of its effectiveness, accessibility, and trainability in detecting hypertensive retinopathy among hypertensive crisis patients in emergency room settings. Methods: A literature search was conducted on PubMed, Google Scholar, and the Cochrane Library for papers published from January 2010 to November 2021. Keywords including hypertensive crisis, hypertensive retinopathy, target organ damage, fundoscopic optic examination, direct ophthalmoscope, fundus images, smartphone fundoscopy, digital fundus camera, and COVID-19 were used. Full papers published in English and s of non-English publications were all reviewed. Results: Eight studies out of 34 fulfilled our search criteria. Five observational studies confirmed the effectiveness of smartphone-based fundoscopy in obtaining fundus images adequate for interpretation compared with those from commercially available fundus cameras. Also, smartphone-based fundoscopy offers time-saving properties as it allows fundus examination to be effectively completed within 74 seconds compared to 130 seconds with a traditional direct ophthalmoscope. Two studies investigated the accessibility of smartphonebased fundoscopy and discovered that fundus images can be obtained by using 20 diopter condensing lenses with the video mode of the smartphone camera, which can be easily provided even at a primary level hospital due to their low cost. Another study reviewed the trainability of the smartphone-based fundoscopy in 137 undergraduate medical students which concluded that 75% of these students can identify the optic nerve within 20-25 minutes of face-to-face demonstration. Conclusion: With a greater diagnostic capability, accessibility, and trainability of smartphone-based fundoscopy makes it a potentially game-changing technique for detecting hypertensive retinopathy in hypertensive emergency patients, especially during the current COVID-19 pandemic, in which longer working distance and shorter doctor-patient contact time are both required.
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Finding effective and safe medicines to fight SARS-CoV-2 infection is an urgent task. RPH-137 is an original trap fusion protein against SARS-CoV-2 virus. It comprises the angiotensin-converting enzyme type 2 extracellular domain and the human IgG1 Fc fragment. The aim of the study was to carry out a preclinical evaluation of the efficacy of RPH-137 and molnupiravir against SARS-CoV-2 infection. Materials and methods: the authors analysed RPH-137 expressed in a stable CHO cell line and molnupiravir used as an active pharmaceutical ingredient. Drug-mediated inhibition of virus-induced cytotoxicity was assessed in Vero cell culture. In vivo efficacy assessments were performed in Syrian hamsters. The animals were infected intranasally with SARS-CoV-2 (PIK35 clinical isolate) in the dose of 5 log TCID50. The authors evaluated body weight measurements, lung-body weight ratios, and lung histopathology findings and determined viral RNA levels in oropharyngeal swabs by RT-PCR using the amplification cycle threshold (Ct). The statistical analyses involved one- and two-way ANOVA, Student's t-test, and Mann–Whitney test. Results: RPH-137 and molnupiravir inhibited the cytopathic effect of SARS-CoV-2 in Vero cells;the EC50 values of RPH-137 amounted to 4.69 μg/mL (21.3 nM) and 16.24 μg/mL (73.8 nM) for 50 TCID50 and 200 TCID50, respectively, whereas the EC50 values of molnupiravir were 0.63 μg/mL (1900 nM) for both doses. Intramuscular RPH-137 (30 and 80 mg/kg) had no effect on the infection process in Syrian hamsters. The comparison with the challenge control group showed that intraperitoneal RPH-137 (100 mg/kg) had statistically significant effects on a number of parameters, including a 27% reduction in inflammation and a 30% reduction in the total lesion area of the lungs by Day 7. Intragastric molnupiravir (300 mg/kg twice daily) significantly inhibited SARS-CoV-2 infection. Conclusions: both RPH-137 and molnupiravir inhibited the cytopathic effect of SARS-CoV-2 in Vero cells. In Syrian hamsters, molnupiravir demonstrated a more pronounced inhibition of SARS-CoV-2 than RPH-137. However, RPH-137 had statistically significant effects on a range of parameters. This offers additional perspectives for further research.
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This study compared the efficacy of different therapies for ARVI during the COVID-19 pandemic. Objective. To compare clinical efficacy of Cycloferon and Ingavirin in children aged 4–17 years treated in outpatient facilities during the epidemic season of СOVID-19. Patients and methods. This study included 101 patients who provided 143 oro-and nasopharyngeal swabs tested using certified PCR tests. Of them, 128 samples (89.5%) were positive, whereas 15 samples (10.5%) were negative. We identified the most common viruses circulating in January–May 2021, including (seasonal) coronaviruses (35.9%), rhinoviruses (20.3%), and other viruses. We also analyzed respiratory viruses that have circulated in Moscow during the last 6 years and found higher levels of seasonal coronaviruses. The most common ARVI symptoms in 2021 were fever, rhinitis, pharyngeal hyperemia, and fatigue. Fewer children had headache, cough, and enlarged lymph nodes. Results. We compared ARVI treatment with broad-spectrum antivirals in children aged between 4 and 17 years. Children in group 1 (n = 51) received Cycloferon®, while children in Group (n = 50) received Ingavirin®. Study participants were diagnosed with ARVI and moderate nasopharyngitis. Children from the Cycloferon group demonstrated a more significant dynamics of such clinical symptoms as headache (p < 0.05), cough (p < 0.01), rhinitis (p < 0.01), abundant mucus (p < 0.001), and enlarged lymph nodes (p < 0.001) than children from the Ingavirin group (there was a significant difference in the duration of these symptoms). Only 2 children from group 1 required antibiotics (3.4%), whereas in group 2, 11 children needed antibacterial therapy (22%).
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Objective: As of December 2021, two types of vaccines are applied in our country: inactive Coronavac and BNT162b2 mRNA vaccine. In this study, it was aimed to compare the rates of Covid-19 disease infection, pneumonia development rates and hospitalization requirement of individuals vaccinated with different vaccines. Materials and methods: Individuals at least one dose vaccinated with Coronavac inactive or mRNA active were compared for the evaluation of oxygen saturation values, SARS-CoV-2 reverse transcriptase polymerase chain reaction (RT-PCR) results for the development of pneumonia, and hospitalization. Results: 71 individuals vaccinated with mRNA vaccine and 145 individuals vaccinated with inactive Coronavac vaccine, a total of 216 individuals were evaluated. There was no significant difference between the two groups in terms of the presence of fever complaints and Sars-CoV-2 Reverse Transcriptase Polymerase Chain Reaction (RT-PCR) positivity rates. 5.6% (n=4) of the individuals vaccinated with the mRNA vaccine had pneumonic infiltration on non-contrast computed tomography (CT) images of the thorax, while 2.8% (n=2) required hospitalization. 17.9% (n=4) of the individuals vaccinated with inactive Coronavac vaccine had pneumonic infiltration on non-contrast thoracic CT images, while 11.7% (n=17) had hospitalization requirement. Conclusion: There are currently no studies in the literature comparing the effectiveness of an inactive vaccine and an mRNA vaccine. In our study, we concluded that even if people vaccinated with the mRNA vaccine were infected with Sars-CoV-2, the pneumonic involvement and hospitalization requirements for thoracic CT were lower compared to those without the vaccine and those vaccinated with the inactive Coronavac vaccine.
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Background: There has been an increase in the occurrence of sudden onset functional tic-like behaviours (FTLBs) in adolescents during the COVID-19 pandemic, which has had a significant impact on the affected individual's quality of life and access to education. Support for the management of FTLBs following diagnosis is limited and, when it is available, waiting lists to receive such support are long. Objective(s): Our aim was to devise and evaluate psychoeducation materials to guide carers and schools in how best to support young people with the day-to-day management of FTLBs. Method(s): A 3-h clinician-led webinar for carers and an advice sheet for schools were developed. The webinar was attended by 20 carers and the advice sheet was sent to a selection of schools of young people attending our service. Carers attending the webinar completed a pre-and post-evaluation measure and feedback was gained on the advice sheet via consultation with schools and young people. Result(s): Results from the completed evaluation measures indicated an improvement in carers' understanding of FTLBs and their management and increased confidence in supporting their child with the movements both at home and school. Initial consultation with schools and young people regarding the advice sheet for schools suggests the resource increased their understanding of FTLBS and gave useful management strategies. Conclusion(s): Psychoeducation resources can serve as an important component of a wider support package for young people with FTLBs. We highlight the need for further evaluation of the effectiveness of such resources, in particular, any direct impact on FTLBs.
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Behavioural therapy is the main form of symptomology management for tics, such as Exposure Response Prevention (ERP) and Habit Reversal Therapy (HRT), and is typically administered in person. Due to challenges presented by COVID-19, this was no longer possible, raising questions surrounding the effectiveness of alternative delivery methods. The current study assesses the efficacy of virtually delivered tic therapy in a group setting. Delivered by the Tics and Neurodevelopmental Movements Service (TANDeM) at the Evelina London Children's Hospital, combined ERP and HRT delivered virtually with externalised attention strategies is a pioneering combination and has not yet been explored. Method(s): Sixteen TANDeM patients attended a six-session virtual tic therapy group, each lasting 1 h. The Yale Global Tic Severity Scale (YGTSS) was completed for all patients prior to and following the group, and qualitative feedback was also gathered post-hoc regarding satisfaction and acceptability of the management techniques. Results and Conclusion(s): Patients' post-group YGTSS scores showed a statistically significant improvement compared to pre group scores, and all patients reported better management of tics after having attended the virtual group. 91.6% of attendees returned positive feedback for the virtual aspect, such as it being 'more accessible', and availability of 1:1 practice with clinicians. Twelve of 16 attendees reported learning combined ERP and HRT to manage their tics was the main attraction of the group. The cost-effective virtual group produced a significant improvement in patient outcome, suggesting it is an effective way of delivering tic therapy. The significant difference between pre-and post-group YGTSS scores provides a preliminary basis for delivering combined ERP and HRT alongside externalised attention strategies.
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The aim of this study was to analyze the efficacy and safety of using etiotropic therapy with favipiravir and molnupiravir that can selectively bind and inhibit not only SARS-CoV-2 proteins but also other RNA-containing pathogens of acute respiratory diseases. High transmission of pathogens, the risk of becoming chronic, frequent complications, cases of co-infection with several pathogens, which can lead to a more severe course of the disease, insufficient vaccination effectiveness, all this requires additional strategies for both prevention and treatment of acute respiratory viral infections. RNA-dependent RNA polymerase (RdRp), which has no equivalent in human cells, is involved in RNA synthesis and is an excellent therapeutic target for diseases caused by RNA viruses, including SARS-CoV-2. The long process of drug development and the "reuse" of drugs approved for other indications or successfully tested in terms of safety and tolerability pose the challenge of rapid establishment of an effective drug, including for the treatment of severe cases of COVID-19. Copyright © 2022, Dynasty Publishing House.
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Background: Patients with SLE are at high risk of COVID-19 infection due to the disease itself and to steroids and immunosuppressive treatments. COVID-19 vaccine is crucial for reducing the severity and spread of the virus. However, vaccine hesitancy is a significant barrier to infection control. Accurate vaccine information contributes to increased vaccine acceptance. There is a lack of research on vaccine hesitancy and educational interventions in patients with SLE. Objective(s): The current study determines the prevalence and reasons for vaccine hesitancy in patients with SLE. Additionally, we evaluate the effectiveness of educational interventions. Method(s): This prospective study enrolled 305 patients with SLE between July and December 2021. The data included demographics, disease activity as measured by the Systemic Lupus Erythematosus Disease Activity Index 2000 (SLEDAI-2 K), and medication. A score of >4 on the SLEDAI-2 K or >3 on the modified SLEDAI-2 K indicated active disease. Each patient completed a vaccination questionnaire before receiving the COVID-19 vaccination. We identified vaccine hesitancy rate and three main concerns regarding efficacy, side effects, and disease interference. Vaccine information was then provided, including the risks and benefits of vaccination following a standardized guideline. During the follow-up, the first vaccination was documented as vaccination acceptance. The factors associated with vaccine hesitancy were investigated using multivariate analysis. A P-value of 0.05 was considered statistically significant. Result(s): The majority of patients (94.4%) were female, with an average age of 46.6 years and a disease duration of 13.5 years. A mean period between follow-ups was 18.8 weeks. Half of patients (50.2%) had a low level of education. Only 23% of patients had active disease. Steroids and immunosuppressive treatment were 57.4 and 42.0%, respectively. COVID-19 vaccine hesitancy was observed in 86 (28.2%) of patients, with 36 (11.8%) refusing vaccination and 50 (16.4%) remaining indecisive. Concerns regarding the vaccination's efficacy were stated by 24.3 percent of all patients, 70.2 percent concerning side effects, and 70.5 percent about the vaccine exacerbating SLE activity. The educational intervention boosted vaccination acceptance from 71.8% to 94.1% in patients who were previously hesitant to vaccination. Low level of education was the only factor associated with vaccine hesitancy (P = 0.018). Conclusion(s): COVID-19 vaccine hesitancy is low in Thai patients with SLE. Most individuals are concerned about the vaccine's adverse effects and negative impact on SLE activity. Patients with a low level of education are prone to exhibit vaccine hesitancy. Appropriate vaccine education significantly increases vaccination acceptability.
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The post-COVID-19 recovery period is characterized by persistence of some symptoms, with immunological alterations being of great importance. Development of preventive measures to normalize mucosal immunity after a coronavirus infection determines the relevance of the current study. The aim was to study dynamics of clinical symptoms and level of secretory immunoglobulin A in individuals after a novel coronavirus infection as well as evaluate effectiveness of using IFNalpha-2b. Materials and methods. A study was conducted with patients aged 18 to 60 years old (n = 130), surveyed 1 to 9 months after post-infection, as well as in apparently healthy individuals lacking COVID-19 (n = 15). Previous novel coronavirus infection and post-COVID manifestations were verified based on medical documentation, complaints, anamnesis data, physical examination and questionnaires. The concentration of salivatory and nasopharyngeal mucosal sIgA was measured dynamically prior to and after administration of local therapy with IFNalpha-2b (gel applied intranasally twice a day for 30 days). Results. The acute period of COVID-19 was characterized by fever, anosmia, severe asthenia (fatigue and weakness), muscle and joint pain. Among the post-COVID manifestations at early period (1-3 months), pain in the joints and muscles (75.0%) as well as elevated body temperature (21.2%) were reliably detected, whereas in the long period (6-9 months) there were revealed dominance with the same frequency of shortness of breath, muscle and joint pain (75.8%, respectively). Based on examination data in healthy subjects, there was determined an arbitrary normal range of secretory IgA in saliva - 6.45+/-1.81 mg/ml and nasal swabs - 13.43+/-3.24 mg/ml. In the group of patients 1-3 months post-infection, therapy with IFNalpha-2b one month later resulted in significantly increased level of secretory IgA in saliva (from 1.84+/-0.28 to 5.78+/-1.96 mg/ml) and in nasal swabs (from 28.61+/-3.0 to 39.83+/-3.85 mg/ml) by more than 3- and 1.5-fold, respectively. In the group of patients without therapy was featured with stably sustained decline in sIgA level up to 9 months after COVID-19. In particular, the level of saliva sIgA ranged from 2.36+/-0.56 down to 2.16+/-0.66 mg/ml, and in nasal smears - from 15.66+/-1.32 to 10.23+/-1.07 mg/ml that differed insignificantly compared to baseline level. The rate of respiratory diseases prevailed in this group (27.6% of cases), which fully lacked in the group of topically administered IFNalpha-2b. Conclusion. In the post-COVID period, multiple organ disorders persist and reduced sIgA level is registered. Intranasally applied IFNalpha-2b made possible to normalize sIgA level and prevent accumulation of respiratory infectious pathologies. Copyright © 2022 Saint Petersburg Pasteur Institute. All rights reserved.
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The proceedings contain 380 papers. The topics discussed include: fecal microbiota transplantation with anti-inflammatory diet followed by anti-inflammatory diet alone is effective in inducing and maintaining remission over 1 year in mild to moderate ulcerative colitis - a randomized controlled trial;gut microbial dysbiosis, gut barrier integrity, and severity of chronic pancreatitis: exploring a mechanistic link using an experimental model;acanthosis nigricans-a rare cutaneous association in progressive familial intrahepatic cholestasis type 3;liver mass presenting as acute cardiorespiratory failure;role of serum phosphate levels in acute-on-chronic liver failure patients to predict short-term mortality;association of liver dysfunction in corona virus disease-19 patients;diabetic with emphysematous liver abscess: a case report;non HFE hemochromatosis - the uncommon variant;granulomatous disease with hepatic involvement in a South Indian female;epidemiological profile of acute hepatitis patients hospitalized in a tertiary care center in Western India;and a prospective randomized comparative four arm intervention study of efficacy and safety of saroglitazar and vitamin E in patients with non-alcoholic fatty liver disease/ non-alcoholic steatohepatitis - an interim analysis.
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Background Bowel preparation remains a significant barrier for patients who need to undergo colonoscopy and is recognised by children as the most difficult aspect of the colonoscopy process. Inadequate bowel preparation can lead to increased procedural times, lower caecal intubation rates, and the need for repeat colonoscopy. Practice across paediatric units providing colonoscopy is not uniform with regard to the total number of days of prep prior a colonoscopy and the agent(s) used. Data comparing a two-day regime vs a shorter one-day regime in children is limited. Restrictions during COVID19 including shielding, need for PCR testing, reduction in theatre capacity led to a re-appraisal of the need for a 2-day bowel prep, which was standard practice until 2020. Aim To evaluate the efficacy and safety profile of a shorter 1- day bowel prep regime in children undergoing colonoscopy and compare this to a standard 2-day regime. Methods Data was collected prospectively on patients who were prescribed a one-day regime prior to colonoscopy. The data was then compared with similar data on patients who were prescribed a two-day regime from an audit carried out 1 year prior to the COVID19 pandemic. The one-day regime involved taking a high dose of senna followed by two doses of picolax (dose dependent on age). The two-day regime involved a smaller dose of senna followed by three doses of picolax. Comparison was carried out between the two regimes. Boston Bowel Preparation Scale (BBPS) was used to assess the efficacy of bowel preparation. The maximum score possible for the BBPS is 9, and a score of -2 in all 3 segments is considered optimal for colonoscopy.1 Results There were 24 patients in the one-day bowel prep group and 19 patients in the two-day group. The mean age of children in the two groups were identical (11.4). The majority of patients in both groups received their bowel preparation at home. The indications for colonoscopy were very similar in both cohorts with IBD and PR bleeding being the most common indications. The median BBPS score in the 2- day regime was 6 and was 7 in the 1-day regime. 67% of patients in the one-day group had a BBPS score -2 in all 3 segments compared with only 47% of patients in the two-day group. In each group one procedure could not be completed due to inadequate bowel preparation. Conclusions The one-day bowel preparation was not inferior to the two-day regime. The higher dose of senna used in the shorter 1-day regime was well tolerated. There appears to be little to gain from a longer bowel prep regime. There are several benefits of the one-day regime such as acceptability by patients, fewer days off school/work, reduced numbers of medication doses, and fewer inpatient hospital days necessary to admit for supervised bowel prep.
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Pneumonia associated by the new coronavirus infection COVID-19 is leads to dysfunctions of the respiratory system, higher mental functions, functions of the cardiovascular system and, unfortunately, possible disability. The World Health Organisation Disability Assessment Schedule (WHODAS 2.0) is a practical, generic assessment instrument that can measure health and disability at population level or in clinical practice (World Health Organisation [WHO], 2010). Objective(s): To assess the effectiveness of the use of lowfrequency magnetotherapy in the complex medical rehabilitation of patients who have had pneumonia in the phase of convalescence according to the WHODAS 2.0. Material(s) and Method(s): The study included 90 patients with pneumonia associated with COVID-19, mean age 60.3 +/- 5.8 years. Group 1 (main) (n = 45) received pulsed low-frequency magnetic field magnetotherapy with the BTL 4920 device daily for 15 minutes, for a course of 15 treatments, on a standard treatment background for 10 days at the beginning of the illness. The second (control) group consisted of 45 patients who did not receive Pulsed Magnetic Field lowfrequency magnetotherapy with the BTL 4920 device . For each patient, the severity of the initial manifestations of respiratory failure was assessed using the mMRC (shortness of breath) and Borg scales, spirometry findings, the Hospital Anxiety and Depression Scale (HADS), and WHODAS 2.0. Results and discussion: In 43 % (20 people) of patients of the 1th group, an improvement in respiration functions was noted with lung auscultation and with spirometry, an increase in the vital capacity of the lungs by 28.2 %, an increase in chest excursion by 53.1 % a decrease in the level of shortness of breath by 50 % and Borg by 33.3 %. In the 1st group of patients, WHODAS 2. 0, which reflects the level of functioning in six domains of life, showed improvements: cognition - understanding and communication in 45 % of patients;mobility - moving and handling in 87 % of patients;self-care - hygiene, dressing, eating and staying in 87 % of patients;getting along - interacting with other people in 45 % of patients;life activities - home duties, leisure, work and school in 100 % of patients;participation - involvement in community activities, participation in society in 100 % of patients. In group 1, a reduction in the length of stay on the sick list of 3.4 +/- 0.2 days was observed.In the 1st group a decrease in the duration of being on the sick list was observed for 3.4 +/- 0.2 days. Conclusion(s): The inclusion of Pulsed Magnetic Field lowfrequency magnetic therapy in the complex rehabilitation of patients who have suffered pneumonia associated by COVID-19 contributes to improving the function of external respiration of patients, regression of residual infiltrative changes in the lungs after pneumonia, relief of residual manifestations of the inflammatory process, reducing the duration of the rehabilitation period and the duration of disability, improving the general well-being of patients, increasing tolerance to physical exertion, normalization of the psycho-emotional state and, as a result, restoring activity in everyday life and improving the quality of life of patients. The researchers did not register any side effects and side effects of magnetic therapy..
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Princess Margaret Cancer Centre (PM) receives roughly 120 new patients (pts) per year with uveal melanoma (UM). Moderate to high-risk pts, based on AJCC staging and cytogenetics, undergo a strict surveillance program for metastases with liver MRI every 4-6 months and annual chest imaging. The importance of surveillance has been highlighted by new therapies which are likely more effective in pts with lower volume metastases. In this single center retrospective study, we assessed the effectiveness of a virtual surveillance model, by comparing UM pts on standard in-person surveillance (SS) pre-COVID (August 2018 to March 2020) with virtual surveillance (VS) after COVID onset (April 2020 to November 2021). Virtual visits were done through phone or MS Teams video calls, and images were done either locally or externally. We identified 106 pts who underwent SS and 107 pts who underwent VS. In the SS group, 10 pts were diagnosed with metastasis and of these 9 (90%) were staged as M1a disease and 1 (10%) was M1b. In the VS group, 20 pts were diagnosed with metastases, 2 (10%) of which had M1b disease and 18 (90%) with M1a disease. Fifteen (14%) pts in the SS group and 34 (20%) pts in the VS group lived out of province;13 (12%) of the SS pts and 36 (21%) of pts in the VS cohort had scans externally. With regards to surveillance adherence in the SS group, 70 (66%) of pts had their scans performed on time versus 127 (75%) of pts in the VS cohort. Virtual screening of pts with moderate to high-risk UM during the COVID 19 pandemic showed similar ability to detect low volume disease compared with our standard screening. There was a higher level of adherence to screening during the VS period. When implemented appropriately, VS appears to be an effective model to monitor UM pts.
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Introduction. The use of telemedicine services has increased worldwide during recent years because of national strategies for digitalization of health care and the coronavirus disease 2019 (COVID-19) pandemic. However, healthcare professionals often express uncertainty regarding the effectiveness of telemedicine interventions. The TELEMED database (https://telemedicine.cimt.dk/) was introduced by the Centre for Innovative Medical Technology (CIMT) at Odense University Hospital to ensure that hospital managers, healthcare professionals, and other stakeholders have access to scientific studies of telemedicine interventions. Methods. The database constitutes a structured literature search in PubMed for randomized and non-randomized controlled trials on the use of telemedicine for treating somatic diseases in the hospital setting. The search was conducted by staff members in the health technology assessment unit at CIMT. Identified studies were sorted by first screening titles and s and then by reading full-text versions. The data extracted from the studies included setting, intervention, patient group, type of telemedicine, clinical effect, patient perception, and implementation challenges. The value of each study was also assessed with respect to effectiveness. Results. A total of 510 articles were selected for data extraction and assessment. The database provides results from 22 different specialties and can be searched using the criteria of medical specialty, country, technology, clinical effect, patient experience, and economic effect. The database serves as an information platform for clinical departments who wish to implement telemedicine services. It has great potential for supporting digital transformation during COVID- 19 by providing accessible evidence-based information on patient groups and relevant technologies and their effects. More than 95 percent of the studies in the database that compared telemedicine with a control group showed either statistically significant improvements in clinical outcomes with telemedicine or no statistically significant difference between the two groups. Conclusions. The TELEMED database provides an easily accessible overview of existing evidence-based telemedicine services. The database is freely available and is expected to be continuously improved and broadened over time.
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Introduction. At various stages of the COVID-19 pandemic, face coverings have been recommended and encouraged as one of the interventions to reduce transmission of the SARS-CoV-2 virus. However, in the earlier stages of the pandemic, decisions on face coverings relied primarily on evidence based on other viral respiratory infections. More direct evidence on the use of face coverings with COVID-19 developed in tandem with the pandemic. Health Technology Wales undertook an ultra-rapid review to inform national guidelines, the work assessed the evidence on the effectiveness of face coverings to reduce SARS-CoV-2 transmission. We also reviewed evidence on the efficacy of different types of face coverings. Methods.Weconducted a systematic literature search for evidence to address (i) the effectiveness of face coverings to reduce the spread of COVID-19 in the community, and (ii) the efficacy of different types of face coverings designed for use in community settings. We identified a rapid review in 2021 by Public Health England that closely aligned with our review questions. This provided the main source for identifying relevant studies, supplemented by a search for publications following their search date. Results. We identified two evidence reviews (including the Public Health England review) that examined the effectiveness of face coverings on reducing transmission of SARS-CoV-2;reporting on 31 and 39 studies, respectively. Two further primary studies were published after the two evidence review searches were included. Overall, the evidence suggested that face coverings may provide benefits in preventing SARS-CoV-2 transmission, although the higher-quality studies suggested that these benefits may be modest. Medical masks appeared to have higher efficacy than fabric masks, although the evidence was mixed. Conclusions. At the time of this review, evidence on the effectiveness of face coverings remains limited and conclusions rely on low-quality sources of evidence with high risk of bias, although higher-quality evidence points to some benefit. Face coverings may play a role in preventing transmission of SARS-CoV-2, particularly as part of a bundle of other preventative measures.
ABSTRACT
Introduction. The outbreak of the COVID-19 global pandemic in 2020 has been a major challenge for the world's population and governments. The lack of vaccines, the saturation of health systems, and its rapid spread forced governments to take non-pharmacological interventions (NPI) that had a high impact on the population. Assessing the efficacy of these measures is a challenge for health technology assessment bodies. Methods. The main NPIs for which assessment was required were: mobility restrictions, social distancing, cancellation of events or reduction of seating capacity, closure or reduction of seating capacity in non-essential businesses, closure or limitation of seating capacity in educational establishments, and promotion of teleworking in potential jobs. The implementation of these measures at a global level provides a large population for the study of the impact of these measures. However, the challenges for their evaluation are numerous: * The joint implementation of these measures makes it difficult to evaluate them in an isolated manner. * The heterogeneity between countries and regions of the pandemic situation at the time when these measures are initiated and terminated. * The different accuracy in the application of the measures. * Heterogeneity in the quality and accessibility of public health services for citizens. Results. Outcome variables to assess the effectiveness of these measures should include parameters related to: * Incidence variables: the number of new or accumulated cases in a given time range, the variation in the number of cases in a given time range and the proportion of positive tests. * Transmission variables: the basic reproductive number (R0) and the effective reproductive number (Rt). * Severity and mortality variables: the number or variation of hospitalizations, the number or variation of intensive care unit (ICU) hospitalizations and the number or variation of deaths. Conclusions. The large number of available data, the heterogeneity of the measures, the differences between populations, the numerous outcome variables and the possible inclusion of mathematical modelling studies, are a methodological challenge for the HTA bodies.
ABSTRACT
Aim/Introduction: Airborne infections are particularly challenging for in-patient care units. In general, hospitals take more precautions to prevent airborne spread of diseases and several guidelines recommend expiratory filters during nebulizer therapies to reduce exhaled bioaerosols. However, a substantial reduction of virusloaded aerosols depend on a high filter performance for particles 100 -500nm in size. This study aimed to test the effectiveness of filter pads in the reduction of exhaled aerosols by applying 99mTclabeled graphite aerosol. Material(s) and Method(s): In 37 patients with suspected pulmonary embolism or CTEPH an inhalation scintigraphy was performed with 99mTc-labeled graphite aerosol (Technegas ©, particle size 30 -60nm ). The exhalate was filtered by a PARI filter/valve set equipped with a PARI filter pad and then collected in a plastic bag reservoir. Count rates of the filter pads and reservoirs were estimated by planar imaging within a SPECT/ CT. In addition, the individual volumes of the exhaled air were determined. The percentage filter efficacy of the filter pads was calculated. Finally, correlational statistics (Spearman's correlation) addressing the following interactions were performed: (1) exhalate volume and count rates of the filter pads, (2) filter pads' count rates and filter retention efficacy, and (3) exhaled breath volume and filter retention efficacy. Result(s): Mean count rates of the filter pads and the reservoirs containing the filtered exhalate were 26023 +/- 8327 cts/s and 169 +/- 153 cts/s, respectively. The efficacy of the PARI filter/ valve set with PARI filter pad was 98.5 +/- 0.9% (range 96.2 -99.7%). The mean exhaled volume was 9.5 +/- 4.6 l (range 2.4 -21.0 l). The exhalate volumes positively correlate with the filter pad count rates (p=0.006) which, in turn, negatively correlate with the filter pad efficacy (p=0.04). However, an inter-relation of exhaled breath volume and filter pad efficacy failed to reach significance (p=0.07). Conclusion(s): The filter pad of the PARI filter/valve set demonstrated a high retention rate of aerosol particles < 100nm in size. Therefore, in patients suffering from respiratory infections these filter pads used in expiratory filters are suitable to substantially reduce airborne virus load, e.g. COVID-19 SARS CoV2, in their exhalates. Additionally, we found evidence that the filter retention efficacy decreased with increased filter particle load indicating a need for regular filter changes.