scholarly journals 539. Impact of Corticosteroids when Combined with Tocilizumab or Remdesivir for the Treatment of Severe SARS-CoV-2

2021 ◽  
Vol 8 (Supplement_1) ◽  
pp. S371-S371
Author(s):  
Michael Rosati ◽  
Nikunj M Vyas ◽  
Cindy Hou
Keyword(s):  
Statistical Difference ◽  
Primary Objective ◽  
Nasal Cannula ◽  
Ordinal Scale ◽  
Inpatient Mortality ◽  
High Flow Nasal Cannula ◽  
Primary Endpoints ◽  
Secondary Objective ◽  
Oxygen Requirements ◽  
Oxygenation Status

Abstract Background Tocilizumab (TCZ) and remdesivir (RDV) have both shown benefit for patients with SARS-CoV-2. However, there have been no head to head studies comparing the efficacy of the two therapies. The purpose of this study is to compare clinical outcomes of patients who have received corticosteroids (CS) along with TCZ or RDV. Methods This is an IRB approved retrospective observational study completed in a three hospital health system in New Jersey. Patients were included if age was ≥ 18, admitted with SARS-CoV2 infection requiring oxygen. Patients were stratified into two treatment arms; CS + TCZ and CS + RDV. The primary objective was to compare all-cause inpatient mortality (ACIM) based on oxygenation status; nasal cannula (NC), high-flow nasal cannula (HFNC), and invasive mechanical intubation (IMV). Secondary objectives was a snapshot analysis with a focus on clinical improvement (CI) defined as improvement in clinical ordinal scale by 2 or more at end of stay. Additional endpoint included progression to IMV after therapy initiation. Results There were total of 1053 patients included (123 in the CS+TCZ arm, 930 in the CS+RDV arm). Oxygen requirements were as follows: In the CS+TCZ arm (NC n=57, HFNC n=26, IMV n=40), and the RD+CS arm (NC n=669, HFN n=159, and IMV n=102). Results from the primary endpoints can be found in Table 1. No statistically significant differences were observed between the two treatment arms. For the secondary objective there were 214 patients included (70 in the CS+TCZ arm and 105 in the CS+RDV arm). For patients receiving NC, no difference seen in CI between two treatment arms (81.4% CS+RDV vs. 81.5% CS+TCZ). In HFNC group more patients in the CS+TCZ group observed CI compared to CS+RDV (68.8% vs. 40%). Less patients requiring HFNC progressed to IMV in CS+TCZ group (25%) compared to CS+RDV (40%). Conclusion No statistical difference in ACIM was detected between the two treatment arms regardless of baseline oxygenation requirements. There was a trend towards lower ACIM for IMV patients in the CS+TCZ arm compared to the CS+RDV arm. More patients experienced CI in CS+TCZ group compared to CS+RDV in HFNC group. Less HFNC patients also required new IMV in the CS+TCZ arm. Larger studies need to be performed to evaluate a true statistical difference between the two treatment arms. Disclosures All Authors: No reported disclosures

Increased use of heated humidified high flow nasal cannula is associated with longer oxygen requirements

2017 ◽  
Vol 53 (12) ◽  
pp. 1215-1219 ◽  
Author(s):  
Rachael C Heath Jeffery ◽  
Margaret Broom ◽  
Bruce Shadbolt ◽  
David A Todd
Keyword(s):  
High Flow ◽  
Nasal Cannula ◽  
High Flow Nasal Cannula ◽  
Oxygen Requirements

scholarly journals Impact of FilmArray Pneumonia Panel on Early Targeted Antibiotic Therapy

2020 ◽  
Vol 41 (S1) ◽  
pp. s260-s261
Author(s):  
Cindy Hou ◽  
Shereef Ali ◽  
Nikunj Vyas
Keyword(s):  
Staphylococcus Aureus ◽  
Influenza A ◽  
Primary Objective ◽  
Inpatient Mortality ◽  
Infectious Disease Physician ◽  
Comfort Care ◽  
Resistance Patterns ◽  
Secondary Objective ◽  
Resistance Rates ◽  
Care Culture

Background: Patients with pneumonia are frequently recipients of broad-spectrum antibiotics while awaiting maturation of respiratory cultures. FilmArray pneumonia panel (FPP) is an option for more expeditious identification of pathogen(s). We evaluated the utility of FPP in early de-escalation or escalation of antibiotics. Methods: FPP tests were performed on adults hospitalized with pneumonia. The microbiologist directly communicated the organisms, colony counts, and resistance patterns to the infectious disease physician or pharmacist. These results were also compared with pathogen identification and resistance patterns from a VITEK-2 system. The primary objective of this analysis was to evaluate the rates of de-escalation, escalation, and discontinuation of therapy and their impact on inpatient mortality. The secondary objective of the analysis was to evaluate the confirmation of detected organisms and resistance patterns by FPP. Results: In total, 26 patients included in the analysis. The median age was 70 years and 62% of patients were men; 50% of these patients were critically ill. In the cohort, the most commonly identified organisms were Pseudomonas aeruginosa (31%) and Staphylococcus aureus (30%). Other common organisms were Moraxella catarrhalis (23%) and influenza A (15%). The CTX-M resistance gene was seen in 30% of Enterobacteriaceae cultures, and the MecA/C and MREJ genes were detected in 75% of Staphylococcus aureus cultures. As a result of FPP, de-escalation occurred at a rate of 62%; discontinuation occurred at 42%; and escalation occurred 23%. Inpatient mortality was similar among the 3 groups: de-escalation, 37.5%; discontinuation, 45.5%; escalation, 50%. Notably, 82% of patients received comfort care. Organisms and resistance rates were confirmed with respiratory cultures in 54% of patients. Conclusions: Utilizing FPP yielded high rates of de-escalation, discontinuation, and escalation of antibiotics. No impact noted on inpatient mortality was noted; most of these patients were managed by comfort care. Culture confirmation rates were low due to the variety of sample types. We believe that the use of FPP for bronchoscopy and endotracheal cultures would have the highest impact on antibiotic stewardship efforts.Funding: NoneDisclosures: None

Cancer-Related Pain Is an Independent Predictor of In-Hospital Opioid Overdose: A Propensity-Matched Analysis

Pain Medicine ◽  
2019 ◽  
Vol 20 (12) ◽  
pp. 2552-2561 ◽  
Author(s):  
Nnaemeka E Onyeakusi ◽  
Fahad Mukhtar ◽  
Semiu O Gbadamosi ◽  
Adebamike Oshunbade ◽  
Adeyinka C Adejumo ◽  
...  
Keyword(s):  
Length Of Stay ◽  
Postoperative Pain Management ◽  
Hospital Charge ◽  
Primary Objective ◽  
Hospital Charges ◽  
Opioid Overdose ◽  
Inpatient Mortality ◽  
Total Hospital ◽  
Total Hospital Charge ◽  
Secondary Objective

Abstract Background About 50% of patients with cancer who have undergone surgery suffer from cancer-related pain (CP). The use of opioids for postoperative pain management presents the potential for overdose, especially among these patients. Objective The primary objective of this study was to determine the association between CP and postoperative opioid overdose among inpatients who had undergone major elective procedures. The secondary objective was to assess the relationship between CP and inpatient mortality, total hospital charge, and length of stay in this population. Methods Data of adults 18 years and older from the National Inpatient Sample (NIS) were analyzed. Variables were identified using ICD-9 codes. Propensity-matched regression models were employed in evaluating the association between CP and outcomes of interest. Results Among 4,085,355 selected patients, 0.8% (N = 2,665) had CP, whereas 99.92% (N = 4,082,690) had no diagnosis of CP. We matched patients with CP (N = 2,665) and no CP (N = 13,325) in a 1:5 ratio. We found higher odds of opioid overdose (adjusted odds ratio [aOR] = 4.82, 95% confidence interval [CI] = 2.68–8.67, P < 0.0001) and inpatient mortality (aOR = 1.39, 95% CI = 1.11–1.74, P = 0.0043) in patients with CP vs no CP. Also, patients with CP were more likely to stay longer in the hospital (12.76 days vs 7.88 days) with higher total hospital charges ($140,220 vs $88,316). Conclusions CP is an independent risk factor for opioid overdose, increased length of stay, and increased total hospital charges.

The Student Room Survey: Changes in the Post Graduate Study for Cardiothoracic Surgery

2020 ◽  
Vol 23 (2) ◽  
pp. 71-74
Author(s):  
Md Faizus Sazzad ◽  
Mohammed Moniruzzaman ◽  
Dewan Iftakher Raza Choudhury ◽  
Arif Ahmed Mohiuddin ◽  
Raafi Rahman ◽  
...  
Keyword(s):  
Thoracic Surgery ◽  
Retrospective Analysis ◽  
Primary Objective ◽  
Graduate Study ◽  
Postgraduate Students ◽  
Depth Interview ◽  
Secondary Objective ◽  
Cardio Vascular ◽  
The University ◽  
Day By Day

Background: The number of postgraduate students in Cardiac surgical discipline is increasing day by day with incremental proportion are measurably suffering from the unnecessary lingering of the present course curriculum. The primary objective of this study was to find out the last 5 years’ of results of Masters in Surgery course under the University of Dhaka from a student room survey. A secondary objective was to find out positive changes that could show us the way of a step toward up-gradation. Methods: It is a retrospective analysis of all examination results of Cardio-vascular & Thoracic Surgery published since January 2008 to January 2013 from the University of Dhaka with in depth interview of 11 participants. Results: 85.24% students failed to pass part-I of Masters in Surgery for Cardio-vascular & Thoracic Surgery course while, 82.18% in part-II and 71.28% failed to pass the final part. Average 2.51 attempts needed to complete each part of the designed course resulted into lingering of course duration for 42.18 months/student. In the thoracic surgery discipline the number of students alarmingly reduced up to 0% in the recent academic sessions. Conclusions: Masters in Surgery is resulting in unnecessary prolongation of the course. We should step forward to meet the next generation challenge. Journal of Surgical Sciences (2019) Vol. 23(2): 71-74

Epidemiology of pheochromocytoma and paraganglioma: population-based cohort study

2021 ◽  
Vol 184 (1) ◽  
pp. 19-28
Author(s):  
Alexander A Leung ◽  
Janice L Pasieka ◽  
Martin D Hyrcza ◽  
Danièle Pacaud ◽  
Yuan Dong ◽  
...  
Keyword(s):  
Cohort Study ◽  
Administrative Data ◽  
Laboratory Data ◽  
Population Based ◽  
Incidence Rates ◽  
Primary Objective ◽  
Administrative Databases ◽  
Secondary Objective ◽  
True Frequency ◽  
Clinical Records

Objective Despite the significant morbidity and mortality associated with pheochromocytoma and paraganglioma, little is known about their epidemiology. The primary objective was to determine the incidence of pheochromocytoma and paraganglioma in an ethnically diverse population. A secondary objective was to develop and validate algorithms for case detection using laboratory and administrative data. Design Population-based cohort study in Alberta, Canada from 2012 to 2019. Methods Patients with pheochromocytoma or paraganglioma were identified using linked administrative databases and clinical records. Annual incidence rates per 100 000 people were calculated and stratified according to age and sex. Algorithms to identify pheochromocytoma and paraganglioma, based on laboratory and administrative data, were evaluated. Results A total of 239 patients with pheochromocytoma or paraganglioma (collectively with 251 tumors) were identified from a population of 5 196 368 people over a period of 7 years. The overall incidence of pheochromocytoma or paraganglioma was 0.66 cases per 100 000 people per year. The frequency of pheochromocytoma and paraganglioma increased with age and was highest in individuals aged 60–79 years (8.85 and 14.68 cases per 100 000 people per year for males and females, respectively). An algorithm based on laboratory data (metanephrine >two-fold or normetanephrine >three-fold higher than the upper limit of normal) closely approximated the true frequency of pheochromocytoma and paraganglioma with an estimated incidence of 0.54 cases per 100 000 people per year. Conslusion The incidence of pheochromocytoma and paraganglioma in an unselected population of western Canada was unexpectedly higher than rates reported from other areas of the world.

High-Flow Nasal Cannula on Neonatal Transport: Table

PEDIATRICS ◽  
2016 ◽  
Vol 137 (Supplement 3) ◽  
pp. 642A-642A
Author(s):  
Vivien Carrion ◽  
Matthew Parrish ◽  
Praveen Chandrasekharan
Keyword(s):  
High Flow ◽  
Nasal Cannula ◽  
High Flow Nasal Cannula ◽  
Neonatal Transport

Incidência da utilização de protetores bucais em diversos esportes de contato

2020 ◽  
Vol 12 (45) ◽  
pp. 118-122
Author(s):  
Victor Paes Dias Gonçalves ◽  
Hugo Leonardo Matias Nahmias ◽  
Marcus Menezes Alves Azevedo
Keyword(s):  
Martial Arts ◽  
Rio De Janeiro ◽  
Dental Trauma ◽  
Primary Objective ◽  
Type Ii ◽  
Contact Sports ◽  
The Face ◽  
Secondary Objective ◽  
The City

Among contact sports, the practice of martial arts offers a greater risk of causing dental trauma and fractures as contact with the face is more frequent. The primary objective of the research is to evaluate the incidence of mouthguard use, and the secondary objective is to verify which type has a greater predominance and the difficulties in its use correlating to the type of mouthguard used. A documentary study was carried out with 273 athletes of different contact sports, among them: MMA, Boxing, Muay Thai, Jiu-Jitsu, and Taekwondo of the city of Campos dos Goytacazes, Rio de Janeiro, Brazil. It was concluded that the most commonly used mouthguard is PB Boils and Bites - Type II and its level of approval is poor, interfering with the athletes’ performance, mainly in relation to the breathing factor.

Do Second-Time Users of Topical Imiquimod have a More Rapid Onset of Clinical Response?

2018 ◽  
Vol 2 (3) ◽  
pp. 156-161
Author(s):  
Stacy L McMurray ◽  
Matthew Reynolds ◽  
Matthew S Dinehart ◽  
Scott M Dinehart
Keyword(s):  
Clinical Response ◽  
Time Use ◽  
Γδ T Cells ◽  
Rapid Onset ◽  
Primary Objective ◽  
Imiquimod Cream ◽  
Actinic Keratoses ◽  
Topical Imiquimod ◽  
Primary Endpoints ◽  
Time To Onset

Introduction: Topical imiquimod is commonly used in dermatology for treatment of actinic keratoses (AK). Prior studies in humans and mice have suggested the potential for immune recall with imiquimod based on higher degrees of AK clearance and activation of memory γδ T-cells in a mouse model. Anecdotal reports suggest a more rapid time-to-onset of clinical response with second time use of imiquimod. However, the potential for immune recall demonstrated by time-to-onset of clinical response has not been formally investigated.Objective:  The primary objective of this study was to determine if there is a difference in time-to-onset of clinical response between naïve and prior users of topical imiquimod for the treatment of actinic keratoses.Methods:  A total of 92 patients were treated with 5% imiquimod cream for actinic keratoses of the head and neck. Patients were instructed to apply 5% imiquimod cream to the affected areas once daily until reaching a therapeutic endpoint of crusting/scabbing. The primary endpoints in the study were time (days) to onset of erythema and time to onset of crusting/scabbing. Results were self-reported.Results:  The average time (days) to onset of erythema was 5.48 ± 3.19 days in naïve users and 4.7 ± 2.91 days in prior users (p= 0.22). Average time to onset of crusting/scabbing was 9.2 ± 4.34 days in naïve users and 9.02 ± 3.65 days in prior users (p=0.35).Conclusion:  Our study revealed there is no difference in time-to-onset of erythema or scabbing/crusting with second-time use of imiquimod.  While immune recall may be possible with use of imiquimod, the results of this study indicate that it may be independent of time-to-onset of clinical response.  

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