scholarly journals Outcomes of Anti-Spike Monoclonal Antibody Therapy in Pregnant Women with Mild to Moderate COVID-19

2021 ◽  
Author(s):  
Bright P Thilagar ◽  
Aditya K Ghosh ◽  
Jerome Nguyen ◽  
Regan N Theiler ◽  
Myra J Wick ◽  
...  
Keyword(s):  
Monoclonal Antibodies ◽  
High Risk ◽  
Adverse Effects ◽  
Chart Review ◽  
Antibody Therapy ◽  
Ebstein Anomaly ◽  
Fetal Demise ◽  
Risk Patients ◽  
Midwest Region ◽  
In Pregnancy

Objective: To evaluate the efficacy and safety of anti-spike monoclonal antibodies (MAb) in the treatment of mild to moderate COVID-19 in high-risk patients who are pregnant. Methods: The database of patients treated with monoclonal antibodies in the Mayo Clinic Midwest region was reviewed for patients who were pregnant at the time of infusion. Manual chart review was performed to collect demographic details as well as COVID course for both the mother and the infant if delivered. The data are presented using descriptive methods. Results: We identified fifty-one pregnant patients with mild to moderate COVID-19 who were treated with MAb (4 with bamlanivimab monotherapy, 3 with bamlanivimab-etesevimab combination, and 44 with the casirivimab-imdevimab combination). No adverse effects were reported, and no patient required COVID-19 related hospitalization. Twenty-nine patients delivered healthy babies, there was one case of intrauterine fetal demise secondary to a congenital Ebstein anomaly (not related to MAb treatment), and twenty-one were uncomplicated pregnancies. Conclusion: MAb infusions were well tolerated in pregnant patients considered at high risk for COVID-19 complications, with no observed adverse effects to mother or fetus. Although preliminary data suggest MAb therapy in pregnancy is safe, further research is recommended to fully assess safety and efficacy in pregnancy.

scholarly journals Oral Metronomic Maintenance Therapy Can Improve Survival in High-Risk Neuroblastoma Patients Not Treated with ASCT or Anti-GD2 Antibodies

Cancers ◽  
2021 ◽  
Vol 13 (14) ◽  
pp. 3494
Author(s):  
Xiaofei Sun ◽  
Zijun Zhen ◽  
Ying Guo ◽  
Yuanhong Gao ◽  
Juan Wang ◽  
...  
Keyword(s):  
High Risk ◽  
Conventional Treatment ◽  
Maintenance Treatment ◽  
Antibody Therapy ◽  
Aggressive Treatment ◽  
Newly Diagnosed ◽  
Event Free Survival ◽  
Free Survival ◽  
Stage 4 ◽  
Risk Patients

Despite aggressive treatment, the prognosis of high-risk NB patients is still poor. This retrospective study investigated the benefits of metronomic maintenance treatment (MT) in high-risk NB patients without ASCT or GD2 antibody therapy. Patients aged ≤ 21 years with newly diagnosed high-risk NB were included. Patients with complete/very good partial remission (CR/VGPR/PR) to conventional treatment received, or not, oral metronomic MT for 1 year. Two hundred and seventeen high-risk NB patients were enrolled. One hundred and eighty-five (85%) had a CR/VGPR/PR to conventional treatment, of the patients with stage 4, 106 receiving and 61 not receiving oral metronomic MT, and the 3-year event-free survival (EFS) rate was 42.5 ± 5.1% and 29.6 ± 6%, respectively (p = 0.017), and overall survival (OS) rate was 71.1 ± 4.7% and 59.4 ± 6.4%, respectively (p = 0.022). A total of 117 high-risk patients with oral metronomic MT had EFS rate of 42.7 ± 4.8%. The toxicity of MT was mild. For high-risk NB patients without ASCT or anti-GD2 antibody therapy, stage 4, MYCN amplication and patients with stage 4 not receiving oral metronomic MT after CR/VGPR/PR were independent adverse prognostic factors. Oral metronomic MT can improve survival in high-risk NB patients in CR/VGPR/PR without ASCT or anti-GD2 antibodies therapy.

Oxycodone-induced neurotoxicity secondary, to concurrent voriconazole use in a patient with cancer

2017 ◽  
Vol 13 (3) ◽  
pp. 141 ◽  
Author(s):  
Lana Alghothani, MD ◽  
Jillian Gustin, MD
Keyword(s):  
Chronic Pain ◽  
High Risk ◽  
Adverse Effects ◽  
Advanced Disease ◽  
Hematologic Malignancies ◽  
Patients With Cancer ◽  
Concurrent Use ◽  
Underlying Malignancy ◽  
Risk Patients ◽  
Active Disease

Chronic pain is common in patients with underlying malignancy with prevalence of up to 70 percent in those with advanced disease. Opioids are often used for those with both active disease and chronic cancer-related pain. In high-risk patients with hematologic malignancies and pneumonia, the Infectious Diseases Society of America recommends empiric antifungal therapy, often with voriconazole or another similar azole agent. Thus, patients with cancer are commonly on medications, such as antifungals, that have the potential to interact with opioids, causing adverse effects. Our case demonstrates severe neurotoxicity due to the concurrent use of voriconazole and oxycodone.

Screening for Thyroid Dysfunction in 1st Trimester of Pregnancy

2016 ◽  
Vol 8 (2) ◽  
pp. 154-156
Author(s):  
Bharath Ramji ◽  
Kavitha Karthikeyan ◽  
Prabha Swaminathan ◽  
Amrita Priscilla Nalini ◽  
Annie Thatheus
Keyword(s):  
High Risk ◽  
Thyroid Dysfunction ◽  
Strong Association ◽  
Thyroid Stimulating Hormone ◽  
Low Risk ◽  
Routine Screening ◽  
High Risk Patients ◽  
Number Of Patients ◽  
Risk Patients ◽  
In Pregnancy

ABSTRACT This study was done to find the prevalence of newly diagnosed thyroid dysfunction in early pregnancy in patients attending the antenatal clinic and to emphasize the need for routine screening for thyroid dysfunction in pregnancy. Free thyroxine (FT4) and thyroid stimulating hormone (TSH) levels were measured and cut-off levels set at FT4 0.86—1.86 ng/dl, TSH 0.1—2.5 mIU/l in 1st trimester, TSH 0.1—3 mIU/l in 2nd and 3rd trimesters. A total of 956 pregnant women were screened in 1st trimester after excluding patients with known thyroid dysfunction. About 13.2% were diagnosed as hypothyroid and 1.6% as hyperthyroid. Incidence in high-risk patients was 21.7% and in low-risk was 10.4%. High-risk factors have a strong association for hypothyroidism (p < 0.001). Screening only high-risk patients will miss a significant number of patients seen positive in the low-risk group. Hence, it is essential to do routine screening for thyroid dysfunction in pregnancy. How to cite this article Karthikeyan K, Swaminatan P, Nalini AP, Ramji B, Thatheus A. Screening for Thyroid Dysfunction in 1st Trimester of Pregnancy. J South Asian Feder Obst Gynae 2016;8(2):154-156.

scholarly journals SARS-CoV-2 Spike Protein-Directed Monoclonal Antibodies May Ameliorate COVID-19 Complications in APECED Patients

2021 ◽  
Vol 12 ◽  
Author(s):  
Elise M. N. Ferré ◽  
Monica M. Schmitt ◽  
Sebastian Ochoa ◽  
Lindsey B. Rosen ◽  
Elana R. Shaw ◽  
...  
Keyword(s):  
Monoclonal Antibodies ◽  
High Risk ◽  
Severe Disease ◽  
Ventilatory Support ◽  
Host Cells ◽  
Spike Protein ◽  
Type I ◽  
Clinical Effects ◽  
High Risk Patients ◽  
Risk Patients

Patients with the monogenic immune dysregulatory syndrome autoimmune polyendocrinopathy-candidiasis-ectodermal dystrophy (APECED), which is caused by loss-of-function mutations in the autoimmune regulator (AIRE) gene, uniformly carry neutralizing autoantibodies directed against type-I interferons (IFNs) and many develop autoimmune pneumonitis, both of which place them at high risk for life-threatening COVID-19 pneumonia. Bamlanivimab and etesevimab are monoclonal antibodies (mAbs) that target the SARS-CoV-2 spike protein and block entry of SARS-CoV-2 in host cells. The use of bamlanivimab and etesevimab early during infection was associated with reduced COVID-19–associated hospitalization and death in patients at high risk for progressing to severe disease, which led the US Food and Drug Administration to issue an emergency use authorization for their administration in non-hypoxemic, non-hospitalized high-risk patients. However, the safety and efficacy of these mAbs has not been evaluated in APECED patients. We enrolled two siblings with APECED on an IRB-approved protocol (NCT01386437) and admitted them prophylactically at the NIH Clinical Center for evaluation of mild-to-moderate COVID-19. We assessed the safety and clinical effects of early treatment with bamlanivimab and etesevimab. The administration of bamlanivimab and etesevimab was well tolerated and was associated with amelioration of COVID-19 symptoms and prevention of invasive ventilatory support, admission to the intensive care, and death in both patients without affecting the production of antibodies to the nucleocapsid protein of SARS-CoV-2. If given early in the course of COVID-19 infection, bamlanivimab and etesevimab may be beneficial in APECED and other high-risk patients with neutralizing autoantibodies directed against type-I IFNs.

Is there a role for referral of high-risk patients seen in preoperative medical consultation for postoperative inpatient follow-up?

2021 ◽  
pp. 175045892110310
Author(s):  
Jessica Evans ◽  
James Chan ◽  
Delvina H Saraqini ◽  
Ranjeeta Mallick
Keyword(s):  
High Risk ◽  
Chart Review ◽  
Hospital Admissions ◽  
Hospital Readmissions ◽  
Retrospective Chart Review ◽  
Medical Consultation ◽  
Medical Assessment ◽  
Risk Patients ◽  
Lost To Follow Up

The potential benefit of referring select high-risk surgical patients who are seen during a preoperative medical consultation for postoperative inpatient medical follow-up is uncertain. Over a seven-year period, our internal medicine perioperative clinic referred 5% of 4642 preoperative consults for postoperative follow-up. A retrospective chart review found that although reasons for referral were heterogeneous, those assessed by the medical consult team postoperatively were more comorbid, had more adverse medical complications and had longer hospital admissions compared to those not referred. Physicians were best able to predict adverse cardiac and diabetes-related complications. Half of the patients who were referred for postoperative assessment were lost to follow-up, and there was a trend towards increased hospital readmissions in this group. Further research is required to identify the subset of patients who might benefit from postoperative inpatient medical assessment.

Validation of an Automated Surveillance Approach for Drain-Related Meningitis: A Multicenter Study

2015 ◽  
Vol 36 (1) ◽  
pp. 65-75 ◽  
Author(s):  
Maaike S. M. van Mourik ◽  
Annet Troelstra ◽  
Jan Willem Berkelbach van der Sprenkel ◽  
Marischka C. E. van der Jagt-Zwetsloot ◽  
Jolande H. Nelson ◽  
...  
Keyword(s):  
Cerebrospinal Fluid ◽  
High Risk ◽  
Prediction Model ◽  
Chart Review ◽  
Routine Care ◽  
High Risk Patients ◽  
Neurosurgical Patients ◽  
Risk Patients ◽  
Automated Surveillance ◽  
Healthcare Associated

OBJECTIVEManual surveillance of healthcare-associated infections is cumbersome and vulnerable to subjective interpretation. Automated systems are under development to improve efficiency and reliability of surveillance, for example by selecting high-risk patients requiring manual chart review. In this study, we aimed to validate a previously developed multivariable prediction modeling approach for detecting drain-related meningitis (DRM) in neurosurgical patients and to assess its merits compared to conventional methods of automated surveillance.METHODSProspective cohort study in 3 hospitals assessing the accuracy and efficiency of 2 automated surveillance methods for detecting DRM, the multivariable prediction model and a classification algorithm, using manual chart review as the reference standard. All 3 methods of surveillance were performed independently. Patients receiving cerebrospinal fluid drains were included (2012–2013), except children, and patients deceased within 24 hours or with pre-existing meningitis. Data required by automated surveillance methods were extracted from routine care clinical data warehouses.RESULTSIn total, DRM occurred in 37 of 366 external cerebrospinal fluid drainage episodes (12.3/1000 drain days at risk). The multivariable prediction model had good discriminatory power (area under the ROC curve 0.91–1.00 by hospital), had adequate overall calibration, and could identify high-risk patients requiring manual confirmation with 97.3% sensitivity and 52.2% positive predictive value, decreasing the workload for manual surveillance by 81%. The multivariable approach was more efficient than classification algorithms in 2 of 3 hospitals.CONCLUSIONSAutomated surveillance of DRM using a multivariable prediction model in multiple hospitals considerably reduced the burden for manual chart review at near-perfect sensitivity.Infect Control Hosp Epidemiol 2015;36(1): 65–75

scholarly journals Cardiomyopathy and pregnancy

Heart ◽  
2019 ◽  
Vol 105 (20) ◽  
pp. 1543-1551 ◽  
Author(s):  
Maria Schaufelberger
Keyword(s):  
Heart Failure ◽  
High Risk ◽  
Right Ventricular ◽  
Dilated Cardiomyopathy ◽  
Ventricular Arrhythmias ◽  
Left Ventricular ◽  
Peripartum Cardiomyopathy ◽  
High Risk Patients ◽  
Risk Patients ◽  
In Pregnancy

Cardiomyopathy is a group of disorders in which the heart muscle is structurally and functionally abnormal in the absence of other diseases that could cause observed myocardial abnormality. The most common cardiomyopathies are hypertrophic and dilated cardiomyopathy. Rare types are arrhythmogenic right ventricular, restrictive, Takotsubo and left ventricular non-compaction cardiomyopathies. This review of cardiomyopathies in pregnancy shows that peripartum cardiomyopathy is the most common cardiomyopathy in pregnancy. Peripartum cardiomyopathy develops most frequently in the month before or after partum, whereas dilated cardiomyopathy often is known already or develops in the second trimester. Mortality in peripartum cardiomyopathy varies from <2% to 50%. Few reports on dilated cardiomyopathy and pregnancy exist, with only a limited number of patients. Ventricular arrhythmias, heart failure, stroke and death are found in 39%–60% of high-risk patients. However, patients with modest left ventricular dysfunction and good functional class tolerated pregnancy well. Previous studies on >700 pregnancies in 500 women with hypertrophic cardiomyopathy showed that prognosis was generally good, even though three deaths were reported in high-risk patients. Complications include different types of supraventricular and ventricular arrhythmias, heart failure and ischaemic stroke. Recent studies on 200 pregnancies in 100 women with arrhythmogenic right ventricular cardiomyopathy have reported symptoms, including heart failure in 18%–33% of pregnancies. Ventricular tachycardia was found in 0%–33% of patients and syncope in one patient. Information on rare cardiomyopathies is sparse and only presented in case reports. Close monitoring by multidisciplinary teams in referral centres that counsel patients before conception and follow them throughout gestation is recommended.

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