Pub Date : 2021-08-18DOI: 10.1101/2021.08.15.21261584
M. Sughayer, A. Mansour, Abeer Al Nuirat, L. Souan, Rashid H. Abdel-Razeq, M. Siag
Objectives: To determine the impact of the second wave of COVID-19 and the vaccination campaign on the seroprevalence rates of SARS-CoV-2 antibodies among healthy blood donors in Jordan. Methods: Sera from 536 healthy adult blood donors collected in June -2021 were tested using a commercially available quantitative assay for the total antibodies including IgG against the spike (S) protein receptor binding domain (RBD) of the SARS-CoV-2. Results: 399 (74.4%) of the donors tested positive for the antibodies of whom 69 (17.3%) were confirmed to have been previously infected, 245(61.4%) have received at least one dose of the vaccine and 123(30.8%) were neither diagnosed nor vaccinated. The seropositive donors were significantly more likely to have been vaccinated or previously infected. Conclusion: The crude seroprevalence rate of 74.4% among this group of healthy donors may be encouraging in terms of approaching herd immunity, however with predominance of the delta variant and the uncertainty regarding the required level of herd immunity this goal appears to be far from full achievement in Jordan.
{"title":"A second dramatic rise in seroprevalence rates of SARS-CoV-2 antibodies among adult healthy blood donors in Jordan; have we achieved herd immunity?","authors":"M. Sughayer, A. Mansour, Abeer Al Nuirat, L. Souan, Rashid H. Abdel-Razeq, M. Siag","doi":"10.1101/2021.08.15.21261584","DOIUrl":"https://doi.org/10.1101/2021.08.15.21261584","url":null,"abstract":"Objectives: To determine the impact of the second wave of COVID-19 and the vaccination campaign on the seroprevalence rates of SARS-CoV-2 antibodies among healthy blood donors in Jordan. Methods: Sera from 536 healthy adult blood donors collected in June -2021 were tested using a commercially available quantitative assay for the total antibodies including IgG against the spike (S) protein receptor binding domain (RBD) of the SARS-CoV-2. Results: 399 (74.4%) of the donors tested positive for the antibodies of whom 69 (17.3%) were confirmed to have been previously infected, 245(61.4%) have received at least one dose of the vaccine and 123(30.8%) were neither diagnosed nor vaccinated. The seropositive donors were significantly more likely to have been vaccinated or previously infected. Conclusion: The crude seroprevalence rate of 74.4% among this group of healthy donors may be encouraging in terms of approaching herd immunity, however with predominance of the delta variant and the uncertainty regarding the required level of herd immunity this goal appears to be far from full achievement in Jordan.","PeriodicalId":8282,"journal":{"name":"Archives of Internal Medicine Research","volume":"35 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-08-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"81079675","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2021-07-20DOI: 10.21203/rs.3.rs-716089/v1
E. L. Cordero-Hernández, C. Martínez-Murillo, Gilberto Barranco-Lampón, Itsel Arias-Castro, A. Santoyo-Sánchez, C. Ramos-Peñafiel
Introduction: During the era of COVID-19, an increase has surged in the number of cases of mucormycosis; the use of high doses of steroids, and states of immunosuppression such as diabetes are the main related risk factors. In the treatment of acute leukemia, it is recommended to reduce the dose of chemotherapy, postponing highly myeloablative schemes and the use of caution with monoclonal antibodies. Case presentation: We present the case of a patient (25 years-old male) with acute lymphoblastic leukemia and COVID-19 confirmed infection who developed rhino-cerebral mucormycosis during the induction stage. Conclusion: In the age of COVID-19, taking samples through a nasal swab should be avoided in individuals with risk of infection from mucormycosis, such as diabetes, cancer, or individuals treated with high doses of steroids.
{"title":"Mucormycosis, COVID-19 and Acute Lymphoid Leukemia: Case Report","authors":"E. L. Cordero-Hernández, C. Martínez-Murillo, Gilberto Barranco-Lampón, Itsel Arias-Castro, A. Santoyo-Sánchez, C. Ramos-Peñafiel","doi":"10.21203/rs.3.rs-716089/v1","DOIUrl":"https://doi.org/10.21203/rs.3.rs-716089/v1","url":null,"abstract":"\u0000 Introduction: During the era of COVID-19, an increase has surged in the number of cases of mucormycosis; the use of high doses of steroids, and states of immunosuppression such as diabetes are the main related risk factors. In the treatment of acute leukemia, it is recommended to reduce the dose of chemotherapy, postponing highly myeloablative schemes and the use of caution with monoclonal antibodies. Case presentation: We present the case of a patient (25 years-old male) with acute lymphoblastic leukemia and COVID-19 confirmed infection who developed rhino-cerebral mucormycosis during the induction stage. Conclusion: In the age of COVID-19, taking samples through a nasal swab should be avoided in individuals with risk of infection from mucormycosis, such as diabetes, cancer, or individuals treated with high doses of steroids.","PeriodicalId":8282,"journal":{"name":"Archives of Internal Medicine Research","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-07-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"74351760","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2021-07-11DOI: 10.1101/2021.07.08.21259912
K. Wanaratna, P. Leethong, N. Inchai, W. Chueawiang, P. Sriraksa, A. Tabmee, S. Sirinavin
Objective: To assess the efficacy and safety of Andrographis paniculata extract (APE) in adults with mild COVID-19. Methods: The alcoholic extract of the aerial part of A. paniculata was used. In this randomized, double-blinded, placebo-controlled trial, adults with laboratory-confirmed COVID-19, and mild symptoms were randomized 1:1 to receive APE (60 mg andrographolide, t.i.d, for 5 days) versus placebo, plus standard supportive care. Blood tests for CRP, liver and renal assessment were performed on Days 1, 3, and 5. The outcomes were occurrence of pneumonia detected by chest X-ray, nasopharyngeal SARS-CoV-2 detection by rRT-PCR, changes of CRP levels, and adverse drug reactions. Results: Patients were randomized to receive APE (n=29) or placebo (n=28). Pneumonia occurrence during illness was 0/29 (0%) versus 3/28 (10.7%), (p=0.039); and patients with nasopharyngeal SARS-CoV-2 detection on Day 5 were 10/29 (34.5%) versus 16/28 (57.1%), (p=0.086), for those who received APE and placebo, respectively. All three patients with pneumonia had substantially rising serum CRP; and high CRP levels on Day 5. None had evidence of liver or renal impairment. Conclusion: This AP-extract treatment regimen was potentially effective and safe in adults with mild COVID-19. The rising of CRP suggested disease progression. Further studies are needed.
{"title":"Efficacy and safety of Andrographis paniculata extract in patients with mild COVID-19: A randomized controlled trial","authors":"K. Wanaratna, P. Leethong, N. Inchai, W. Chueawiang, P. Sriraksa, A. Tabmee, S. Sirinavin","doi":"10.1101/2021.07.08.21259912","DOIUrl":"https://doi.org/10.1101/2021.07.08.21259912","url":null,"abstract":"Objective: To assess the efficacy and safety of Andrographis paniculata extract (APE) in adults with mild COVID-19. Methods: The alcoholic extract of the aerial part of A. paniculata was used. In this randomized, double-blinded, placebo-controlled trial, adults with laboratory-confirmed COVID-19, and mild symptoms were randomized 1:1 to receive APE (60 mg andrographolide, t.i.d, for 5 days) versus placebo, plus standard supportive care. Blood tests for CRP, liver and renal assessment were performed on Days 1, 3, and 5. The outcomes were occurrence of pneumonia detected by chest X-ray, nasopharyngeal SARS-CoV-2 detection by rRT-PCR, changes of CRP levels, and adverse drug reactions. Results: Patients were randomized to receive APE (n=29) or placebo (n=28). Pneumonia occurrence during illness was 0/29 (0%) versus 3/28 (10.7%), (p=0.039); and patients with nasopharyngeal SARS-CoV-2 detection on Day 5 were 10/29 (34.5%) versus 16/28 (57.1%), (p=0.086), for those who received APE and placebo, respectively. All three patients with pneumonia had substantially rising serum CRP; and high CRP levels on Day 5. None had evidence of liver or renal impairment. Conclusion: This AP-extract treatment regimen was potentially effective and safe in adults with mild COVID-19. The rising of CRP suggested disease progression. Further studies are needed.","PeriodicalId":8282,"journal":{"name":"Archives of Internal Medicine Research","volume":"1998 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-07-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"78107556","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2021-06-02DOI: 10.21203/RS.3.RS-571738/V1
Luis W Dominguez, Brandon Beattie, Alexander Poulose
BackgroundHealthcare utilization has changed dramatically during the COVID-19 crisis with the most dramatic drops coming in April 2020. While a lot of research has focused on utilization among the privately insured, or on comparing specialty-visits, comparatively less has been published on the effect of payer-mix, particularly Medicaid, on utilization. MethodsMonthly patient volume was gathered across 3 ambulatory primary and urgent care clinics. The timeframe included appointments, walk-ins and virtual visits from January through June 2020, including the nadir in April. Patient volume was then compared to average payer mix over that same time, at each clinic. A simple linear regression was then run, comparing changes in patient volume and percent Medicaid. ResultsTwo clinics had similar payer mixes, and saw similar decreases in utilization. A third clinic with twice as many Medicaid patients, saw only half the reduction in patient volume, during the nadir in April 2020. ConclusionGiven the limited number of data points, a more robust statistical analysis was not possible. A simple regression line indicated a correlation between the proportion of Medicaid patients and demand resilience for healthcare resources. At scale, the Medicaid population may be less vulnerable to variations in utilization, exhibiting less elastic demand, despite a pandemic, for a myriad of reasons.
{"title":"The Effects of Payer-Mix on Utilization during the COVID-19 Pandemic, in Urgent and Primary Care.","authors":"Luis W Dominguez, Brandon Beattie, Alexander Poulose","doi":"10.21203/RS.3.RS-571738/V1","DOIUrl":"https://doi.org/10.21203/RS.3.RS-571738/V1","url":null,"abstract":"\u0000 BackgroundHealthcare utilization has changed dramatically during the COVID-19 crisis with the most dramatic drops coming in April 2020. While a lot of research has focused on utilization among the privately insured, or on comparing specialty-visits, comparatively less has been published on the effect of payer-mix, particularly Medicaid, on utilization. MethodsMonthly patient volume was gathered across 3 ambulatory primary and urgent care clinics. The timeframe included appointments, walk-ins and virtual visits from January through June 2020, including the nadir in April. Patient volume was then compared to average payer mix over that same time, at each clinic. A simple linear regression was then run, comparing changes in patient volume and percent Medicaid. ResultsTwo clinics had similar payer mixes, and saw similar decreases in utilization. A third clinic with twice as many Medicaid patients, saw only half the reduction in patient volume, during the nadir in April 2020. ConclusionGiven the limited number of data points, a more robust statistical analysis was not possible. A simple regression line indicated a correlation between the proportion of Medicaid patients and demand resilience for healthcare resources. At scale, the Medicaid population may be less vulnerable to variations in utilization, exhibiting less elastic demand, despite a pandemic, for a myriad of reasons.","PeriodicalId":8282,"journal":{"name":"Archives of Internal Medicine Research","volume":"3 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-06-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"81403761","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2021-05-20DOI: 10.21203/RS.3.RS-519351/V1
S. Rehman, Aysha Almas, A. Siddiqui, Sania Sabir Sethi, S. Awan, A. Khan
Background: Why STEMI in young South Asians (SAs) has more adverse outcomes compared to elder population is underexplored. We conducted this study to learn about common risk factors, disease patterns and prognostic factors in this population.Methods: It was an observational study from 2013-2019 done at the Aga Khan University Hospital, Karachi, Pakistan, a tertiary care hospital. Patients aged <45 years who presented with their first episode of ST elevated Myocardial Infarction (STEMI) and who underwent Primay PCI were included. Patients with previous MI or revascularization were excluded. Details of risk factors, lesion complexity and outcomes were noted. Main outcome measures were:i. Primary outcome of 30 day All-cause mortalityii. Secondary outcomes: (a) Composite of Shock/CPR/VT/Vfib, (b) Ejection fraction <35%, (c) Delayed discharge >5 daysResults: Of a total of 1207 patients, only 165 patients (13%) were <45 years old. Common risk factors included male gender 90.3%, n=149, obesity in 48.3%, n=69, history of tobacco in 45%, n=74 and positive family history in 48.4%, n=80. LAD was the culprit in 77.0%, n=127 with Single vessel disease (SVCAD) in 68%, n=112. Primary outcome of 30 day All-cause mortality was seen in 3.6%, n=6 patients. Secondary outcomes: (i) Composite of Shock/CPR/VT/Vfib was seen in 12%, n=20 associated to initial SBP <110 mmhg (OR 4.1, 95% CI 1.2-13.4) or heart failure (OR 3.5, 95% CI 1.0-12.6). (ii) Ejection fraction <35% was seen in 29%. n=48 associated to anterior infarction (OR 5.0, 95% CI 1.8-13.5 ), Time to hospital (TTH) >4 hours (OR 2.6, 95% CI 1.0-6.7) and heart failure (OR 5.1, 95% CI 1.7-15.4). (iii) Delayed discharge >5 days was seen in 27.3%, n=45 associated to TTH >4 hours (OR 3.8, 95% CI 1.3-11.2), the Composite of Shock/CPR/VT/VF (OR 6.4, 95% CI 1.9-21.6) and HTN (OR 2.1, 95% CI 1.0-5.2).Conclusion: Young SAs with STEMI are usually obese, tobacco-users with positive family history. LAD is the most common culprit vessel. Anterior STEMI, delayed presentation, initial SBP, and heart failure may help stratify these patients.
背景:为什么南亚年轻人(SAs)的STEMI与老年人相比有更多的不良后果尚不清楚。我们进行这项研究是为了了解这一人群的常见危险因素、疾病模式和预后因素。方法:这是一项2013-2019年在巴基斯坦卡拉奇阿迦汗大学医院进行的观察性研究，该医院是一家三级保健医院。结果:在1207例患者中，只有165例(13%)患者是4小时(OR 2.6, 95% CI 1.0-6.7)和心力衰竭(OR 5.1, 95% CI 1.7-15.4)。(iii) 27.3% (n=45)患者延迟出院bbb5天与TTH >4小时(OR 3.8, 95% CI 1.3-11.2)、Shock/CPR/VT/VF (OR 6.4, 95% CI 1.9-21.6)和HTN (OR 2.1, 95% CI 1.0-5.2)相关。结论:青年SAs STEMI患者多为肥胖、吸烟、家族史阳性。LAD是最常见的罪魁祸首。前路STEMI、延迟表现、初始收缩压和心力衰竭可能有助于对这些患者进行分层。
{"title":"Young South Asians With ST-Elevation Myocardial Infarction (STEMI) – Outcomes, Clinical and Angiographic Profiles.","authors":"S. Rehman, Aysha Almas, A. Siddiqui, Sania Sabir Sethi, S. Awan, A. Khan","doi":"10.21203/RS.3.RS-519351/V1","DOIUrl":"https://doi.org/10.21203/RS.3.RS-519351/V1","url":null,"abstract":"\u0000 Background: Why STEMI in young South Asians (SAs) has more adverse outcomes compared to elder population is underexplored. We conducted this study to learn about common risk factors, disease patterns and prognostic factors in this population.Methods: It was an observational study from 2013-2019 done at the Aga Khan University Hospital, Karachi, Pakistan, a tertiary care hospital. Patients aged <45 years who presented with their first episode of ST elevated Myocardial Infarction (STEMI) and who underwent Primay PCI were included. Patients with previous MI or revascularization were excluded. Details of risk factors, lesion complexity and outcomes were noted. Main outcome measures were:i. Primary outcome of 30 day All-cause mortalityii. Secondary outcomes: (a) Composite of Shock/CPR/VT/Vfib, (b) Ejection fraction <35%, (c) Delayed discharge >5 daysResults: Of a total of 1207 patients, only 165 patients (13%) were <45 years old. Common risk factors included male gender 90.3%, n=149, obesity in 48.3%, n=69, history of tobacco in 45%, n=74 and positive family history in 48.4%, n=80. LAD was the culprit in 77.0%, n=127 with Single vessel disease (SVCAD) in 68%, n=112. Primary outcome of 30 day All-cause mortality was seen in 3.6%, n=6 patients. Secondary outcomes: (i) Composite of Shock/CPR/VT/Vfib was seen in 12%, n=20 associated to initial SBP <110 mmhg (OR 4.1, 95% CI 1.2-13.4) or heart failure (OR 3.5, 95% CI 1.0-12.6). (ii) Ejection fraction <35% was seen in 29%. n=48 associated to anterior infarction (OR 5.0, 95% CI 1.8-13.5 ), Time to hospital (TTH) >4 hours (OR 2.6, 95% CI 1.0-6.7) and heart failure (OR 5.1, 95% CI 1.7-15.4). (iii) Delayed discharge >5 days was seen in 27.3%, n=45 associated to TTH >4 hours (OR 3.8, 95% CI 1.3-11.2), the Composite of Shock/CPR/VT/VF (OR 6.4, 95% CI 1.9-21.6) and HTN (OR 2.1, 95% CI 1.0-5.2).Conclusion: Young SAs with STEMI are usually obese, tobacco-users with positive family history. LAD is the most common culprit vessel. Anterior STEMI, delayed presentation, initial SBP, and heart failure may help stratify these patients.","PeriodicalId":8282,"journal":{"name":"Archives of Internal Medicine Research","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-05-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"78157156","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2021-03-17DOI: 10.1101/2021.03.15.21253581
Basheer Abdulrahman, W. Aletreby, A. Mady, Alfateh Noor, Mohammed Lhmdi, Fahad Faqihi, A. Alharthy, M. Al-Odat, D. Karakitsos, Z. Memish
Abstract: Since the emergence of the first cases of COVID 19 viral pneumonia late 2019 several studies evaluated the benefits of different treatment modalities. Early in the pandemic, the interleukin 6 (IL 6) receptor antibody Tocilizumab was considered in view of the cytokine release syndrome associated with COVID 19 infection. Several early observational studies showed beneficial effect of treatment with Tocilizumab on mortality, however, results from well designed randomized clinical trials (RCT) were contradicting. Objectives: To perform a systematic literature review and meta-analysis of RCTs utilizing Tocilizumab in the treatment of COVID 19 pneumonia, with in hospital mortality as a primary objective, while secondary objectives included composite outcome of mortality, intubation, or ICU admission, another secondary outcome was super added infection. Method: This was a random effects model (DerSimonian and Laird) model of relative risk (RR), along with corresponding 95% confidence intervals, p values, and forest plots of both primary and secondary outcomes. A fixed effect sensitivity test was performed for the primary outcome, in addition to subgroup and meta regression analyses with predefined criteria. Results: The primary outcome of mortality showed statistically insignificant reduction of mortality with Tocilizumab (RR = 0.9, 95% CI: 0.8 to 1.01; p = 0.09) although with an unmistakable apparent clinical benefit. There was a significant reduction in the RR of the secondary composite outcome (RR = 0.83, 95% CI: 0.76 to 0.9; p < 0.001), and no difference between groups in super added infection (RR = 0.77, 95% CI: 0.51 to 1.19; p = 0.24). Treatment protocol allowing a second dose was the only significant predictor of improved mortality in the meta regression analysis. Certainty of evidence was reduced to moderate for the primary outcome and the secondary outcome of clinical deterioration, while it was reduced to low for the secondary outcome of super added infection. Conclusion: Moderate certainty of evidence suggest no statistically significant improvement of 28-30 day all cause mortality of hospitalized COVID-19 patients treated with TCZ, although there may be clinically important value. Moderate certainty of evidence suggest lowered relative risk of a composite outcome of death or clinical deterioration, while, low grade evidence indicate no increase in the risk of super added infection associated with TCZ treatment. A protocol allowing two doses of TCZ shows evidence of improved mortality as compared to a strictly single dose protocol.
{"title":"Tocilizumab Effect in COVID-19 Hospitalized Patients: A Systematic Review and Meta-Analysis of Randomized Control Trials","authors":"Basheer Abdulrahman, W. Aletreby, A. Mady, Alfateh Noor, Mohammed Lhmdi, Fahad Faqihi, A. Alharthy, M. Al-Odat, D. Karakitsos, Z. Memish","doi":"10.1101/2021.03.15.21253581","DOIUrl":"https://doi.org/10.1101/2021.03.15.21253581","url":null,"abstract":"Abstract: Since the emergence of the first cases of COVID 19 viral pneumonia late 2019 several studies evaluated the benefits of different treatment modalities. Early in the pandemic, the interleukin 6 (IL 6) receptor antibody Tocilizumab was considered in view of the cytokine release syndrome associated with COVID 19 infection. Several early observational studies showed beneficial effect of treatment with Tocilizumab on mortality, however, results from well designed randomized clinical trials (RCT) were contradicting. Objectives: To perform a systematic literature review and meta-analysis of RCTs utilizing Tocilizumab in the treatment of COVID 19 pneumonia, with in hospital mortality as a primary objective, while secondary objectives included composite outcome of mortality, intubation, or ICU admission, another secondary outcome was super added infection. Method: This was a random effects model (DerSimonian and Laird) model of relative risk (RR), along with corresponding 95% confidence intervals, p values, and forest plots of both primary and secondary outcomes. A fixed effect sensitivity test was performed for the primary outcome, in addition to subgroup and meta regression analyses with predefined criteria. Results: The primary outcome of mortality showed statistically insignificant reduction of mortality with Tocilizumab (RR = 0.9, 95% CI: 0.8 to 1.01; p = 0.09) although with an unmistakable apparent clinical benefit. There was a significant reduction in the RR of the secondary composite outcome (RR = 0.83, 95% CI: 0.76 to 0.9; p < 0.001), and no difference between groups in super added infection (RR = 0.77, 95% CI: 0.51 to 1.19; p = 0.24). Treatment protocol allowing a second dose was the only significant predictor of improved mortality in the meta regression analysis. Certainty of evidence was reduced to moderate for the primary outcome and the secondary outcome of clinical deterioration, while it was reduced to low for the secondary outcome of super added infection. Conclusion: Moderate certainty of evidence suggest no statistically significant improvement of 28-30 day all cause mortality of hospitalized COVID-19 patients treated with TCZ, although there may be clinically important value. Moderate certainty of evidence suggest lowered relative risk of a composite outcome of death or clinical deterioration, while, low grade evidence indicate no increase in the risk of super added infection associated with TCZ treatment. A protocol allowing two doses of TCZ shows evidence of improved mortality as compared to a strictly single dose protocol.","PeriodicalId":8282,"journal":{"name":"Archives of Internal Medicine Research","volume":"26 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-03-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"74129635","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pascal Zimmermann, Dusan Harmacek, Fabian Hauenstein, A. Karolin, Anita Hurni, Lucienne Christen, V. Banz, D. Sidler
Background: Previously, pre-existing cancers were considered a contraindication for kidney transplantation. Meanwhile, due to improved screening and treatment options, the prevalence of dialysis patients with cancer history is increasing. Potentially these patients could be eligible for kidney transplantation. Methods: Single center retrospective study, analyzing the incidence and outcome of de novo cancers in kidney transplant recipients with and without pre-existing cancer from 01.01.1981 through 31.12.2018. Results: The incidence of eligible transplant candidates with pre-existing malignancies increased over the last 40 years, primarily due to diagnosis of limited disease during the pre-transplant evaluations. Outcome is good with comparable graft and patient survival. Incidence of recurrent or secondary de novo cancers is low. The average annual incidence of de novo malignancy is 1 per 100 patient years in the post-transplant follow-up. In the last decades, the incidence of kidney cancers decreased, while lung cancers and post-transplant lymphoproliferative disorder (PTLD) increased. The outcome of malignant disease was poor, notably in patients with disseminated disease at presentation and mainly attributed to cancer-related death. Meanwhile, graft losses were rare after diagnosis of de novo malignancy. Conclusions: In summary, the incidence of pre-existing and de novo solid cancers increased within the last four decades in our transplant cohort. Patients with pre-existing cancers have an excellent outcome and – if well selected – should not be excluded from transplantation. Meanwhile, de novo cancers after transplantation are associated with poor outcome.
{"title":"Incidence and Outcome of Post-Transplant Cancer in Kidney Recipients with or without Pre-Transplant Malignancies","authors":"Pascal Zimmermann, Dusan Harmacek, Fabian Hauenstein, A. Karolin, Anita Hurni, Lucienne Christen, V. Banz, D. Sidler","doi":"10.26502/aimr.0074","DOIUrl":"https://doi.org/10.26502/aimr.0074","url":null,"abstract":"Background: Previously, pre-existing cancers were considered a contraindication for kidney transplantation. Meanwhile, due to improved screening and treatment options, the prevalence of dialysis patients with cancer history is increasing. Potentially these patients could be eligible for kidney transplantation. Methods: Single center retrospective study, analyzing the incidence and outcome of de novo cancers in kidney transplant recipients with and without pre-existing cancer from 01.01.1981 through 31.12.2018. Results: The incidence of eligible transplant candidates with pre-existing malignancies increased over the last 40 years, primarily due to diagnosis of limited disease during the pre-transplant evaluations. Outcome is good with comparable graft and patient survival. Incidence of recurrent or secondary de novo cancers is low. The average annual incidence of de novo malignancy is 1 per 100 patient years in the post-transplant follow-up. In the last decades, the incidence of kidney cancers decreased, while lung cancers and post-transplant lymphoproliferative disorder (PTLD) increased. The outcome of malignant disease was poor, notably in patients with disseminated disease at presentation and mainly attributed to cancer-related death. Meanwhile, graft losses were rare after diagnosis of de novo malignancy. Conclusions: In summary, the incidence of pre-existing and de novo solid cancers increased within the last four decades in our transplant cohort. Patients with pre-existing cancers have an excellent outcome and – if well selected – should not be excluded from transplantation. Meanwhile, de novo cancers after transplantation are associated with poor outcome.","PeriodicalId":8282,"journal":{"name":"Archives of Internal Medicine Research","volume":"2 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"84029491","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Sara Whyte, K. Vedala, P. Sobash, Raghuveer Vedala, Kalyan Gonugunta
Electrocardiographic monitoring (telemetry) in the inpatient setting has significant utility, but is constrained by rising healthcare costs, rare detection of significant events and potential for great alert fatigue [1, 2]. In 2017, the American Heart Association (AHA) published updated practice standards for telemetry monitoring that addressed overuse, appropriate use, alarm management and documentation in electronic medical records [3, 4]. Here, we review their recommendations for indication for telemetry utilization on the hospital floor. The rationale for arrhythmia monitoring is for diagnosis and management of arrhythmias, assessing for etiology of syncope, immediate recognition of sudden cardiac arrest to improve time to defibrillation, and catching sustained, life-threatening arrhythmias [5, 6].
{"title":"Appropriate Usage of Continuous Cardiac Monitoring in the Inpatient Setting: A Literature Review","authors":"Sara Whyte, K. Vedala, P. Sobash, Raghuveer Vedala, Kalyan Gonugunta","doi":"10.26502/aimr.0057","DOIUrl":"https://doi.org/10.26502/aimr.0057","url":null,"abstract":"Electrocardiographic monitoring (telemetry) in the inpatient setting has significant utility, but is constrained by rising healthcare costs, rare detection of significant events and potential for great alert fatigue [1, 2]. In 2017, the American Heart Association (AHA) published updated practice standards for telemetry monitoring that addressed overuse, appropriate use, alarm management and documentation in electronic medical records [3, 4]. Here, we review their recommendations for indication for telemetry utilization on the hospital floor. The rationale for arrhythmia monitoring is for diagnosis and management of arrhythmias, assessing for etiology of syncope, immediate recognition of sudden cardiac arrest to improve time to defibrillation, and catching sustained, life-threatening arrhythmias [5, 6].","PeriodicalId":8282,"journal":{"name":"Archives of Internal Medicine Research","volume":"28 6 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"90795026","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
C. Pritchard, B. Birch, T. Hickish, Emily Rosenorn-Lanng
Introduction: Britain’s cancer survival results have been criticised as being significantly higher than twenty Major Developed Countries (MDC). Hence this comparison of current UK Total Age-Standardised-Death-Rates (ASDR), female Breast and Prostate cancer mortality rates with twenty (MDC) between1989 to 2015 to determine any significant change. Method: WHO data ASDR per million (pm) for Total, Breast and Prostate cancer mortality rates examined for the years 1989-91 to 2013-15. Confidence Intervals (+/- 95%) are used to determine any significant differences between the UK and other country’s outcomes over the period. Chi square tests for each nation’s Breast and Prostate mortality. Results: Every country’s Total ASDR, Breast and Prostate cancer mortality fell except Greece and Japan. Total ASDR Male cancer mortality rates ranged from Portugal 1653pm to Sweden 1232pm. UK at 1475pm were 10th but had been 6th highest. Total ASDR Female rates went from Denmark’s 1176pm to Japan’s 740pm, the UK 1092pm now 5th but previously had been second highest. No country’s Total rates fell significantly more than Britain’s who had significantly bigger reductions than four other countries for both sexes. Breast mortality ranged from Ireland’s 206pm to Japan’s 99pm, UK rates fell significantly more than five countries. Whilst Breast mortality fell in every country Norway and UK had significantly bigger reductions in Breast than Prostate deaths, conversely France’s Prostate rates fell more than Breast mortality. Prostate mortality went from Norway 213pm Japan’s 60pm, the UK 167pm and five countries had greater reductions than Britain. Conclusions: Results reflect well on UK services for Total and Breast cancers, showing the NHS achieving more with proportionately less as Britain spends less on health than most MDC. The need how to improve UK prostate results are briefly discussed, such as a public information campaign to match the successful Breast cancer aware programme of the 1990’s.
{"title":"Comparing Total Neoplasms, Breast & Prostate Cancer Mortality Rates of the UK and 20 Major Developed Countries 1989-91 v 2013-15 - Identifying Progress","authors":"C. Pritchard, B. Birch, T. Hickish, Emily Rosenorn-Lanng","doi":"10.26502/AIMR.0050","DOIUrl":"https://doi.org/10.26502/AIMR.0050","url":null,"abstract":"Introduction: Britain’s cancer survival results have been criticised as being significantly higher than twenty Major Developed Countries (MDC). Hence this comparison of current UK Total Age-Standardised-Death-Rates (ASDR), female Breast and Prostate cancer mortality rates with twenty (MDC) between1989 to 2015 to determine any significant change. Method: WHO data ASDR per million (pm) for Total, Breast and Prostate cancer mortality rates examined for the years 1989-91 to 2013-15. Confidence Intervals (+/- 95%) are used to determine any significant differences between the UK and other country’s outcomes over the period. Chi square tests for each nation’s Breast and Prostate mortality. Results: Every country’s Total ASDR, Breast and Prostate cancer mortality fell except Greece and Japan. Total ASDR Male cancer mortality rates ranged from Portugal 1653pm to Sweden 1232pm. UK at 1475pm were 10th but had been 6th highest. Total ASDR Female rates went from Denmark’s 1176pm to Japan’s 740pm, the UK 1092pm now 5th but previously had been second highest. No country’s Total rates fell significantly more than Britain’s who had significantly bigger reductions than four other countries for both sexes. Breast mortality ranged from Ireland’s 206pm to Japan’s 99pm, UK rates fell significantly more than five countries. Whilst Breast mortality fell in every country Norway and UK had significantly bigger reductions in Breast than Prostate deaths, conversely France’s Prostate rates fell more than Breast mortality. Prostate mortality went from Norway 213pm Japan’s 60pm, the UK 167pm and five countries had greater reductions than Britain. Conclusions: Results reflect well on UK services for Total and Breast cancers, showing the NHS achieving more with proportionately less as Britain spends less on health than most MDC. The need how to improve UK prostate results are briefly discussed, such as a public information campaign to match the successful Breast cancer aware programme of the 1990’s.","PeriodicalId":8282,"journal":{"name":"Archives of Internal Medicine Research","volume":"151 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"75171599","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Aswa Gondal, M. Rasheed, S. Ali, Zain Ul Abdin, O. Rahim, Shristee Ghimire, Mohamed A Suleiman, Relfa Dellanira Proano, Ahmad Mashlah, Olasumbo Elizabeth Fagbenle, Jennifer L Okon, Sidra Shahid Mubasher, N. Hussain, A. Nasir, Firas Kadurei
Objective: HIV was diagnosed for the first time in Pakistan in 1987; since then, the prevalence has been gradually increasing and is expected to rise over the next decade. Although the epidemic has been predominantly concentrated in the high-risk groups, the concerning factors include spillover potential in the general population and multiple nosocomial infections. Therefore, we rooted the prevalence of HIV in the populations of Pakistan that were at higher risk and compared it with the prior estimates to guide future interventions. Methods: We conducted a systematic review using keywords in PubMed, Google Scholar, and Pakimedinet.com to identify articles related to HIV frequency in Pakistan from January 1, 2010 to May 15, 2020. After reviewing the articles, 33 met the inclusion criteria for qualitative synthesis. Results: Our results substantiated that the infection rate in blood donors was low yet on the rise with a numerical value of 0.09%. The analysis of high-risk groups estimated the highest infection rates of 28.94% in the intravenous drug users (IVDUs), followed by prisoners (2.28%) and sex workers (2.25%). Conclusion: These estimates are considerably high compared to prior data on this topic and can cause devastating consequences for the population as a whole. Hence, urgent and effective interventions are required to reduce the frequency of HIV in high-risk groups and limit nosocomial epidemics.
{"title":"Prevalence of HIV in Different High-Risk Groups and Associated Risk Factors in Pakistan. A Systematic Review from 2010 to 2020","authors":"Aswa Gondal, M. Rasheed, S. Ali, Zain Ul Abdin, O. Rahim, Shristee Ghimire, Mohamed A Suleiman, Relfa Dellanira Proano, Ahmad Mashlah, Olasumbo Elizabeth Fagbenle, Jennifer L Okon, Sidra Shahid Mubasher, N. Hussain, A. Nasir, Firas Kadurei","doi":"10.26502/aimr.0076","DOIUrl":"https://doi.org/10.26502/aimr.0076","url":null,"abstract":"Objective: HIV was diagnosed for the first time in Pakistan in 1987; since then, the prevalence has been gradually increasing and is expected to rise over the next decade. Although the epidemic has been predominantly concentrated in the high-risk groups, the concerning factors include spillover potential in the general population and multiple nosocomial infections. Therefore, we rooted the prevalence of HIV in the populations of Pakistan that were at higher risk and compared it with the prior estimates to guide future interventions. Methods: We conducted a systematic review using keywords in PubMed, Google Scholar, and Pakimedinet.com to identify articles related to HIV frequency in Pakistan from January 1, 2010 to May 15, 2020. After reviewing the articles, 33 met the inclusion criteria for qualitative synthesis. Results: Our results substantiated that the infection rate in blood donors was low yet on the rise with a numerical value of 0.09%. The analysis of high-risk groups estimated the highest infection rates of 28.94% in the intravenous drug users (IVDUs), followed by prisoners (2.28%) and sex workers (2.25%). Conclusion: These estimates are considerably high compared to prior data on this topic and can cause devastating consequences for the population as a whole. Hence, urgent and effective interventions are required to reduce the frequency of HIV in high-risk groups and limit nosocomial epidemics.","PeriodicalId":8282,"journal":{"name":"Archives of Internal Medicine Research","volume":"25 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"83358464","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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