Using Active Surveillance to Identify Monoclonal Antibody Candidates Among COVID-19-Positive Veterans in the Atlanta VA Health Care System.

Background: Strategies for optimizing identification and outreach to potential candidates for monoclonal antibody (Mab) therapy for COVID-19 are not clear. Using a centralized, active surveillance system, the Atlanta Veterans Affairs Health Care System (AVAHCS) infectious disease (ID) team identified candidates for Mab infusion and provided treatment. Observations: As part of a quality improvement project from December 28, 2020, to August 31, 2021, a clinical team consisting of ID pharmacists and physicians reviewed each outpatient with a positive COVID-19 polymerase chain reaction test daily at the AVAHCS. The clinical team used Emergency Use Authorization (EUA) criteria to determine eligibility. Eligible patients were contacted on the same day of review via telephone to confirm eligibility and obtain verbal consent. Telehealth follow-up occurred on day 1 and day 7 postinfusion to assess for adverse events. In total, 2028 patients with COVID-19 were identified; 289 patients (14%) were eligible, and 132 (46%) received Mab therapy. Similar to AVAHCS demographics, a majority of those who received Mab therapy were non-Hispanic Black patients (65%). The most common comorbidities were hypertension (59%) and diabetes (37%). The median time from symptom onset to positive COVID-19 polymerase chain reaction (PCR) test result was 6 days (range, 0-9), and the median time from positive COVID-19 PCR test result to Mab infusion was 2 days (range, 0-8). Twelve patients (9%) required hospitalization for worsening COVID-19 symptoms postinfusion. No deaths occurred. Conclusions: Combining laboratory surveillance and active screening led to high uptake of Mab therapy and minimized delay from symptom onset to Mab infusion, thereby optimizing outpatient treatment of COVID-19. This approach also successfully screened and treated Black patients in the AVAHCS population.

Differentiating Categories of Violent Adolescent Offending and the Associated Risks in Police and Youth Offending Service Records.

Historical risk assessment forms for a sample of 173 males with a history of violent offending and under supervision by Merseyside Youth Offending Services (YOS) were investigated. Subsequent arrest records were scrutinised in order to obtain a better understanding of the relationship of social and psychological risk factors to offending behavior. The mean age of the sample at the point of contact with YOS was 16.01 (SD = 1.37) with a range between 12 and 18 years. Assault was associated with solo expressive offending, a history of domestic violence, low school attendance and an inability to control impulsivity and aggression. Robbery was associated instrumental and escalated violent offending, psychological disorders, and deviant groups, including family criminal involvement. Risk assessments by professionals and the young people indicated that substance misuse co-occurred with robbery. The findings suggest that solo offenders commit the majority of violent offences and that targeted interventions should distinguish between expressive and instrumental offending.

Use of Baricitinib in Patients With Moderate to Severe Coronavirus Disease 2019.

Hyperinflammation is associated with increased mortality in coronavirus disease 2019 (COVID-19). In this retrospective, uncontrolled patient cohort with moderate -severe COVID-19, treatment with baricitinib plus hydroxychloroquine was associated with recovery in 11 of 15 patients. Baricitinib for the treatment of COVID-19 should be further investigated in randomized, controlled clinical trials.

Pain Palliation Using Hypofractionated Radiotherapy for Unresectable Pancreatic Cancer.

BACKGROUND: Pain is a common symptom for patients with pancreatic cancer and is often treated using palliative radiation therapy. Standard palliative dose regimes typically consist of 2000 cGy to 3000 cGy in 5 to 10 fractions (fx). With the recent advancements in radiation dosimetric planning and delivery, the Juravinski Cancer Centre in Hamilton, Ontario, offers a hypofractionated dose of 2500 cGy in 5 fx for the improvement of pain and tumour control in selected pancreatic cancer patients. This project reviews the safety and efficacy of this prescription. METHODS: A retrospective analysis of 24 patients diagnosed with unresectable pancreatic cancer was conducted. Patient data were collected using in-house medical record systems including MOSAIQ, Meditech, and Centricity. Nonparametric data analysis tests were conducted using Minitab17. RESULTS: Nineteen of 24 patients (79%) reported a decrease in pain levels following radiation and 13 of 18 (72%) showed good local control of the tumour on a follow-up CT scan. Around 30% of patients reported nausea and vomiting and fatigue. Only 13% reported diarrhea and 8% reported constipation. Twenty-one percent reported pain flares. All patients were able to finish the entire treatment without pauses or delays. CONCLUSION: A palliative radiotherapy dose regime of 2500 cGy/5 fx demonstrates a potential for the effective control of pain with limited acute toxicities in patients with unresectable pancreatic cancer. This study aims to indicate the need for further prospective research comparing this regime to other standard treatments in order to determine which is most beneficial for the patient.

A review of tuberculosis: Focus on bedaquiline.

PURPOSE: The history and prevalence of tuberculosis and the role of bedaquiline in multidrug-resistant (MDR) tuberculosis are reviewed. SUMMARY: Tuberculosis continues to cause significant morbidity and mortality worldwide. Increasing rates of drug-resistant tuberculosis are a significant concern and pose serious implications for current and future treatment of the disease. In December 2012, the Food and Drug Administration approved bedaquiline as part of the treatment regimen for pulmonary MDR tuberculosis. Bedaquiline's unique mechanism of action presents an alternative approach to current antimycobacterial killing. By directly inhibiting adenosine triphosphate (ATP) synthase, bedaquiline is effective against both replicating and dormant mycobacteria. Pulmonary cavitary lesions can contain heterogeneous populations. This potential mix of semireplicating and hypometabolic mycobacteria is more difficult to eliminate with conventional antitubercular drugs, thus increasing the risk of resistance. No in vitro cross-resistance between bedaquiline and currently available antitubercular agents has been observed thus far. Because bedaquiline targets a completely different enzyme, cross-resistance with other conventional agents remains unlikely. Enhanced sterilizing capacity via synergistic depletion of ATP further exhibits the promising potential of bedaquiline with pyrazinamide. A course of bedaquiline requires 24 weeks of therapy in combination with other antitubercular drugs. CONCLUSION: The approval of bedaquiline represents a major milestone in MDR tuberculosis therapy. Bedaquiline should be considered in patients who have not responded to a regimen containing four second-line drugs and pyrazinamide and patients with documented evidence of MDR tuberculosis resistant to fluoroquinolones. The exact role of bedaquiline cannot be determined until further efficacy and safety data are obtained through ongoing Phase III trials.