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1.
Voprosy Ginekologii, Akusherstva i Perinatologii ; 21(3):28-35, 2022.
Article in Russian | EMBASE | ID: covidwho-2033519

ABSTRACT

Objective. To assess the effectiveness of different preventive measures for novel coronavirus infection in pregnant women. Patients and Methods. This study included 125 pregnant women hospitalized with moderate to severe laboratory-confirmed SARS-CoV-2 infection between September and November 2021 (the fourth pandemic wave), and 175 pregnant women who were not infected with COVID-19 during the same period. All women in these two groups were comparable for gestational age (II–III trimesters, 24–39 weeks), age (20–40 years), social status, parity, body mass index, and had no known COVID-19 risk factors. Results. Our findings revealed that vaccination 3-5 months before pregnancy (OR = 4.12;95% CI 1.28–13.27;χ2 = 0.022), inconsistent use and/or non-timely replacement of face masks (OR = 5.71;95% CI 2.83–11.51) were associated with the increased risk of COVID-19 in the second and third trimesters of gestation. It was showed that systematic (once in the morning at 24–48-hour intervals) intranasal administration of recombinant interferon alpha-2b (IFN-α;Grippferon) as compared with a single application after exposure to COVID-19 reduced the disease incidence rate and there was no evident risk of illness (OR = 0.08;95% CI 0.05–0.14;19.2% vs 74,3%, p < 0.001). This can be explained by the fact that women were mostly infected in unpredictable conditions (e.g., 29.2% of pregnant women were infected from family members, 23.9% had unknown source of exposure). The use of umifenovir, not currently authorised for the medication-assisted prevention of COVID-19 in pregnant women, and rectal administration of IFN-α suppositories did not reduce the disease incidence rate. Rectal use of IFN-α suppositories by pregnant women off-label increased the incidence (32.0 vs 15.4%, p = 0.001) and risk of developing novel coronavirus infection (OR = 2.58;95% CI 1.48–4.50). Conclusion. There is a need to improve awareness among pregnant women about the mandatory and timely vaccination against COVID-19 during pregnancy and the importance of strict adherence to wearing face masks. Increased efforts should be made to monitor and inform pregnant women about the use of only authorised medication-assisted preventive measures of SARS-CoV-2 infection, such as intranasal administration of recombinant IFN α-2b (Grippferon). During the epidemic rise in COVID-19 cases, the systematic intranasal administration of recombinant interferon-based medication Grippferon (once in the morning at 24–48-hour intervals) is recommended for pregnant women.

2.
Gut ; 71:A5-A6, 2022.
Article in English | EMBASE | ID: covidwho-2005338

ABSTRACT

Background Delays in diagnosis could be patient-related and health-system related. It has been reported that such delays increase overall complications in Inflammatory Bowel Diseases (IBD). The aim of our study was to report on the impact of delays on IBD-related adverse outcomes (AOs), as most hospitals currently face challenges with long waiting lists in the post-Covid-19 era. Methods New patients referred for suspected IBD to a single tertiary care centre between Jan 2013 to Dec 2017 were identified using EMR. For purposes of the study, a cut-off time was set by investigators for each delay-type based on best average hospital waiting times. The reasons for delays in patient journey until start of treatment and data on predefined AOs (steroid & other rescue therapies, hospitalisations, surgery) were recorded for each patient until end of June 2021. The data were analysed using multiple Pearson correlations and Cox proportional Hazard model to determine whether there is a difference in survival without AOs between patients with and without a delay. Results Total of 105 patients were identified using stringent criteria (M=58 ;median age=32y) with a long median followup of 55 months. The most frequent presenting complaints were abdominal pain (44, 41,9%), loose stools (40, 38,1%), bloody diarrhoea (37, 35,2%) and bleeding per-rectum (33, 31,4%) and only 16% declared a family history. 65, 27 and 13 patients had final diagnosis of Ulcerative colitis, Crohn's disease and Unclassified colitis respectively, and analysed collectively. In our cohort, the longest delay-types noted were - patients seeking medical attention (median= 4 months;range 1 to 84 months), arranging gastroenterology clinic review after referral from primary care (median=5 weeks;range 1 to 30 weeks), and waiting for index endoscopy (median=3 weeks;1 to 36 weeks). Patient stratification based on delay-type, using specific cutoff times for each showed a statistically significant difference in survival without AOs for all (when comparing delay v/s no delay). 1. delay in seeking medical attention (cut-off=1m;p=0.004) (figure 1A) . delay in GP referral specialty review (cut-off=1w;p=0.048) . delay in index endoscopy (cut-off= 4w;p=0.01) (Fig 1B) . delay in starting treatment (cut-off= 4w;p=0.03) Conclusion . Several bottlenecks of delays increase AOs in IBD over the follow-up period. . A delay as short as a week, between GP referral specialty review, is significant in determining AOs;this has implications on specialist IBD centres particularly in the post-Covid period. . Endoscopy units should prioritise suspected IBD patients to reduce AOs, which is likely to have implications on service delivery and planning. . Long delays observed in patients seeking medical attention highlights the need for both primary and secondary care to undertake patient education in the community.

3.
British Journal of Haematology ; 197(SUPPL 1):147-148, 2022.
Article in English | EMBASE | ID: covidwho-1861242

ABSTRACT

Apixaban 2.5 mg twice-daily replaced low-molecular-weight-heparin as thromboprophylaxis (TP) for multiple myeloma (MM) patients receiving outpatientbased chemotherapy considered to be high-risk of venous thromboembolism (VTE) on 1st November 2019 in our regional centre. This prospective cohort study aimed to assess the safety and efficacy of apixaban as thromboprophylaxis in highthrombotic risk patients with MM. Data were systematically collected from the electronic noting system for service evaluation, retrospectively for the historic cohort (1st Nov 2018-1st Nov 2019) prior to the introduction of the novel thromboprophylactic strategy, and prospectively (1st Nov 2019-1st Nov 2020) following the change of local guidelines to include apixaban as TP in high-thrombotic risk patients with MM. Exclusion criteria included antithrombotic treatment other than thromboprophylaxis or contraindication to thromboprophylaxis such as thrombocytopenia or doxorubicin use (due to possible drug-drug interaction with apixaban leading to reduced levels). Data collected included previous VTE history, thromboprophylactic agent, thrombosis and bleeding events while on chemotherapy. Primary outcomes included thrombotic and bleeding events. Table 1 demonstrates patient characteristics and results. There were 102 MM patients in the historic and 147 in the prospective cohort. VTE prophylaxis was prescribed in 82 out of 102 (80%) of the historic cohort and 114 out of 147 (78%) of the prospective cohort. In patients not prescribed thromboprophylaxis, the chemotherapy regimen contained Daratumumab in 65% in the historic and 76% in the prospective cohort. After the introduction of the amended thromboprophylactic strategy, prescriptions of apixaban increased from 22out of 82 (27%) to 60 out of 114 (53%), while aspirin prescriptions fell from 51out of 82 (62%) to 47 out of 114 (41%). After the introduction of apixaban as recommended thromboprophylaxis for high thrombotic risk patients, thrombotic events reduced from 3% (3/102) to 1.4% (2/147). All thrombotic events (two deep vein thrombosis [DVT], one pulmonary embolism) in the historic cohort occurred despite aspirin as thromboprophylaxis and on a pomalidomidecontaining regimen. In the prospective cohort, the thrombotic events were a proximal DVT while on aspirin TP and a peripherally inserted central catheter (PICC)-associated thrombosis occurring on no TP. There were no thrombotic events in patients receiving prophylactic apixaban in either cohort. There were five bleeding events in the historic cohort. This included one major bleeding event of a traumatic subdural haematoma (on apixaban TP). There were two clinically relevant non-major bleeding (CRNMB): an episode of frank haematuria and a per rectum bleed secondary to haemorrhoids (aspirin as TP), and two minor bleeds. In the prospective cohort, there was one major bleeding event which was a gastrointestinal bleed requiring a two-unit blood transfusion (aspirin as TP). One CRNMB event included haemoptysis secondary to COVID-19 (apixaban as TP) and eight minor bleeding events, two of which occurred on no TP. Overall, major bleeding occurred in 1.2% (1/82) and CRNMB in 1.2% (1/82) patients on prophylactic apixaban across both cohorts. These data add further support to the use of apixaban rather than LMWH as thromboprophylaxis for myeloma patients is considered to be at high thrombotic risk, with very low rates of thrombosis and acceptably low rates of major and CRNMB..

4.
Voprosy Ginekologii, Akusherstva i Perinatologii ; 20(5):36-42, 2021.
Article in Russian | EMBASE | ID: covidwho-1579505

ABSTRACT

Objective. To evaluate pregnancy and childbirth outcomes after the combined use of VIFERON® (interferon α-2b with antioxidants) rectal suppositories (3,000,000 IU) and VIFERON® gel for external and local use (36,000 IU/g) in the treatment of new coronavirus infection (COVID-19) in pregnant women against the background of standard complex therapy. Patients and methods. A total of 140 pregnant women diagnosed with COVID-19 were examined and divided into two groups: group 1 consisted of 70 patients who received VIFERON® and standard complex therapy;group 2 – 70 patients who received only standard therapy. Results. Patients from group 1 had a significantly decreased incidence of preterm birth, perinatal loss, and severe birth asphyxia. Most of these pregnant women gave birth at 38-40 weeks of gestation, and no antenatal fetal death was recorded. Conclusion. Inclusion of VIFERON® (rectal suppositories and gel for external and local use) in the complex treatment of COVID-19 in pregnant women contributed to more prompt relief of symptoms and improved pregnancy and childbirth outcomes.

5.
Infektsionnye Bolezni ; 19(3):24-29, 2021.
Article in Russian | EMBASE | ID: covidwho-1579502

ABSTRACT

Objective. To evaluate the efficacy and safety of VIFERON® (recombinant interferon α-2b) rectal suppositories and gel for external and local use in the complex therapy of COVID-19 in adult patients. Patients and methods. 140 patients with COVID-19 were included in a prospective comparative controlled research study. The main group consisted of 71 patients who received standard therapy for coronavirus infection in combination with VIFERON® (rectal suppositories 3.000.000 IU for 1 supp. 3 times a day and gel 36.000 IU/g 5 times a day on the surface of nasal mucosa and palatine tonsils for 14 days);the comparison group – 69 patients who received standard therapy. Results. Patients who received VIFERON® complex therapy demonstrated more rapid clinical improvement by reducing the duration of symptoms of weakness and intoxication compared to the patients who received only standard therapy. The high activity of VIFERON® in elimination rate of SARS-CoV-2 RNA in nasopharyngeal samples was shown. The use of VIFERON® made it possible to achieve a stable concentration of IL-6 in the blood serum during the entire follow-up period. There were no adverse events associated with the administration of VIFERON®. Conclusion. The results obtained indicate the superiority of therapy with the inclusion of VIFERON® over standard therapy. Given the favorable safety profile, the studied regimen can be recommended for the treatment of adult patients, especially from risk groups, where the possibilities of conventional etiotropic therapy are limited due to possible toxicological effects.

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