scholarly journals Pneumonia-targeted lopinavir/ritonavir-based treatment for patients with COVID-19: an early-period retrospective single center observational study

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Jongkyu Kim ◽  
Jiwoong Jung ◽  
Tae Ho Kim ◽  
Naree Kang ◽  
Hanzo Choi ◽  
...  
Keyword(s):  
Medical Center ◽  
Antiviral Treatment ◽  
Early Period ◽  
Symptomatic Treatment ◽  
Management Approach ◽  
Oxygen Supplementation ◽  
Comprehensive Management ◽  
Virological Outcomes ◽  
Oxygen Group ◽  
Negative Conversion

Abstract Background Robust evidenced treatment strategy for Coronavirus disease 2019 (COVID-19) has not been established yet. Early, targeted, comprehensive management approach can be essential. Methods A lopinavir/ritonavir (LPV/r)-based antiviral treatment was administered to the patients with computed tomography (CT)-documented pneumonia. Medical records of patients with COVID-19, previously discharged or hospitalized for ≥ 21 days at the Seoul Medical Center from January 29 to April 15, 2020 were reviewed to analyze clinical and virological outcomes. Patients were divided into two groups (PCR-Negative conversion group vs. Non-negative conversion group and requiring oxygen group vs. Non-requiring oxygen group). Results In total, 136 patients with a mean age of 41.8 ± 18.2 years were included with median 3-day delay of hospitalization after illness. Thirteen (9.56%) were initially asymptomatic, and 5 (3.67%) were persistently asymptomatic. Eighty-five (62.5%) had CT-documented pneumonia, 94% of whom received LPV/r treatments. A total of 53 patients (38.97%) had negative polymerase chain reaction (PCR) results within 28 days. Eight (9.4%) out of 85 pneumonic patients received oxygen supplementation. Patients with initial lower respiratory symptoms showed significant delay in PCR negative conversion (> 28 days) (odds ratio [OR] 0.166; 95% confidence interval [CI] 0.067–0.477; P < 0.001). However, antiviral treatment for pneumonic patients was significantly related with early conversion within 28 days (OR 3.049; 95% CI 1.128–8.243; P = 0.028). Increasing age increased the likelihood of oxygen supplementation requirement in the pneumonic patient group (OR 1.108; 95% CI 1.021–1.202; P = 0.014). Conclusions Early, pneumonia targeted LPV/r-based antiviral therapy resulted in a significantly higher probability of negative conversion of PCR within 28 days compared to symptomatic treatment.

scholarly journals 494. COVID-19 Outbreak: A Tale of Two Psych Units

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S313-S314
Author(s):  
Marilou Corpuz ◽  
Ruchika Jain ◽  
Gregory Weston ◽  
Priya Nori ◽  
Priya Nori ◽  
...  
Keyword(s):  
Infection Control ◽  
Medical Center ◽  
Early Period ◽  
Index Patient ◽  
Structural Aspect ◽  
Practice Change ◽  
Mitigation Strategies ◽  
Inpatient Psychiatry ◽  
Control And Prevention ◽  
Infection Control And Prevention

Abstract Background COVID infections in inpatient psychiatry units present unique challenges during the pandemic, including behavioral characteristics of the patients, structural aspect of the unit, type of therapy for the patients. We present COVID outbreaks in psychiatry units in two hospitals in our medical center in Bronx, NY, and describe our mitigation strategies. Methods Hosp A: In the early period of the pandemic in NY, 2 patients in the inpatient psychiatry unit tested positive for SARS-CoV-2 PCR. The unit was temporarily closed to new admissions. Hosp B: On 4/1, one of the patients in a 22 bed Psych unit, admitted since 3/10/20, developed fever, cough and tested positive for COVID-19 PCR. Two of her close contacts tested positive for SARS-COV-2 PCR. Results Hospital A: In total, 5 of the 29 patients (17.2%) in the unit were SARS-CoV-2 positive, all of whom were asymptomatic. Hospital B: Testing of the remaining patients showed positive PCR in 10/14. PCR tests of healthcare workers (HCW) were positive in 13/46. Except for the index patient, all the patients were asymptomatic but 32/46 HCW reported symptoms. One negative patient subsequently turned positive. Infection control and prevention strategies instituted in both hospitals were the same with subtle differences due to dissimilar burden of infection and structure of the units. Table 1 shows the timing of the outbreak and the rapid institution of preventive measures in each of the hospitals. There was still difficulty with patients regarding adherence. Some of the patients refused to stay in isolation and would roam. Compliance with masking and hand hygiene was problematic. Communication was of paramount importance. Multiple meetings were held between the Psychiatry staff, Infection Control and Prevention team, executive leadership of the hospital. Environmental Services and Engineering were also involved. Communications with the NY State Department of Health occurred frequently. Conclusion Strategies for management of COVID-19 patients in inpatient psychiatric units depends on the density of infected patients in the hospital and in the community. The implementation of practice change may need to be rapidly adjusted depending on the situation and available resources. Contingency plans should be formulated early on. Disclosures Gregory Weston, MD MSCR, Allergan (Grant/Research Support)

scholarly journals Historical perspective of neurology in Iran

2019 ◽  
Author(s):  
Shri Kant-Mishra ◽  
Hadi Mohammad Khanli ◽  
Golnoush Akhlaghipour ◽  
Ghazaleh Ahmadi Jazi ◽  
Shaweta Khosa1
Keyword(s):  
Historical Perspective ◽  
Medical Center ◽  
Medical Science ◽  
Early Period ◽  
Medieval Period ◽  
Neurologic Diseases ◽  
The Past ◽  
Modern Period ◽  
History Of ◽  
Modern Era

Iran is an ancient country, known as the cradle of civilization. The history of medicine in Iran goes back to the existence of a human in this country, divided into three periods: pre-Islamic, medieval, and modern period. There are records of different neurologic terms from the early period, while Zoroastrian (religious) prescription was mainly used until the foundation of the first medical center (Gondishapur). In the medieval period, with the conquest of Islam, prominent scientists were taught in Baghdad, like Avicenna, who referred to different neurologic diseases including stroke, paralysis, tremor, and meningitis. Several outstanding scientists developed the medical science of neurology in Iran, the work of whom has been used by other countries in the past and present. In the modern era, the Iranian Neurological Association was established with the efforts of Professor Jalal Barimani in 1991.

scholarly journals Understanding vernal keratoconjunctivitis in children

2020 ◽  
Vol 79 (1) ◽  
Author(s):  
Hlupheka L. Sithole
Keyword(s):  
Healthcare Providers ◽  
Public Health Problem ◽  
Inflammatory Cells ◽  
Relevant Information ◽  
Vernal Keratoconjunctivitis ◽  
Management Approach ◽  
Comprehensive Management ◽  
Causative Factors ◽  
History Of ◽  
Management Challenge

Background: Vernal keratoconjunctivitis (VKC) is a public health problem that mostly affects children in warm subtropical climates. Unfortunately, the causative factors of the disease are not clearly defined, thus posing a serious management challenge to healthcare providers. It is therefore argued that understanding the pathogenesis of the disease and how various inflammatory cells affect the conjunctiva and the cornea may assist in the management of the disease.Aim: As visual impairment and avoidable blindness are indicated, it is advisable for optometrists to understand the clinical presentation of this chronic condition in order to initiate appropriate interventions and/or immediate referrals where necessary.Methods: A thorough literature search was conducted on peer-reviewed publications on VKC and children. All material obtained were then studied and the information extracted was used to document relevant information required for understanding VKC amongst children.Results: The results in the studied material revealed that VKC was prevalent amongst children aged 2 to 18 years, affecting mostly male children of African and Indian origins. Different strategies of management of the disease have been proposed, including but not limited to explaining to parents the nature of the disease, environmental strategies and preventive measures as well as possible surgical intervention.Conclusion: In view of the nature of this disease, healthcare providers should therefore seek to understand the history of the patient better when such patients present for their first consultation in order to develop a comprehensive management approach.

The Impact of Delayed Symptomatic Treatment Implementation in the Intensive Care Unit

Healthcare ◽  
2021 ◽  
Vol 10 (1) ◽  
pp. 35
Author(s):  
Lesley Meng ◽  
Krzysztof Laudanski ◽  
Mariana Restrepo ◽  
Ann Huffenberger ◽  
Christian Terwiesch
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Medical Center ◽  
Academic Medical Center ◽  
Symptomatic Treatment ◽  
Medication Administration ◽  
Average Delay ◽  
Treatment Implementation ◽  
Medication Delivery ◽  
The Impact

We estimated the harm related to medication delivery delays across 12,474 medication administration instances in an intensive care unit using retrospective data in a large urban academic medical center between 2012 and 2015. We leveraged an instrumental variables (IV) approach that addresses unobserved confounds in this setting. We focused on nurse shift changes as disruptors of timely medication (vasodilators, antipyretics, and bronchodilators) delivery to estimate the impact of delay. The average delay around a nurse shift change was 60.8 min (p < 0.001) for antipyretics, 39.5 min (p < 0.001) for bronchodilators, and 57.1 min (p < 0.001) for vasodilators. This delay can increase the odds of developing a fever by 32.94%, tachypnea by 79.5%, and hypertension by 134%, respectively. Compared to estimates generated by a naïve regression approach, our IV estimates tend to be higher, suggesting the existence of a bias from providers prioritizing more critical patients.

Primary Care Population Management for COVID-19 Patients

2020 ◽  
Author(s):  
MD Deborah Blazey-Martin ◽  
FNP Elizabeth Barnhart ◽  
Joseph Gillis ◽  
Gabriela Andujar Vazquez
Keyword(s):  
Primary Care ◽  
Nurse Practitioners ◽  
Medical Center ◽  
Academic Medical Center ◽  
Physician Assistants ◽  
Population Management ◽  
Severe Illness ◽  
Management Approach ◽  
Primary Care Population ◽  
At Home

Abstract BACKGROUND: Most patients infected with SARS-CoV-2 have mild to moderate symptoms manageable at home; however up to 20% develop severe illness requiring additional support. Primary care practices performing population management can use these tools to remotely assess and manage COVID-19 patients and identify those needing additional medical support before becoming critically ill.AIM: We developed an innovative population management approach for managing COVID-19 patients remotely.SETTING: Development, implementation, and evaluation took place in April 2020 within a large urban academic medical center primary care practice.PARTICIPANTS: Our panel consists of 40,000 patients. By April 27, 2020, 305 had tested positive for SARS-CoV-2 by RT-qPCR. Outreach was performed by teams of doctors, nurse practitioners, physician assistants, and nurses.PROGRAM DESCRIPTION: Our innovation includes an algorithm, an EMR component, and a twice daily population report for managing COVID-19 patients remotely.PROGRAM EVALUATION: Of the 305 patients with COVID-19 in our practice at time of submission, 196 had returned to baseline; 54 were admitted to hospitals, six of these died, and 40 were discharged.DISCUSSION: Our population management strategy helped us optimize at-home care for our COVID-19 patients and enabled us to identify those who require inpatient medical care in a timely fashion.

scholarly journals Telbivudine Reduces Parvovirus B19-Induced Apoptosis in Circulating Angiogenic Cells

Viruses ◽  
2019 ◽  
Vol 11 (3) ◽  
pp. 227 ◽  
Author(s):  
Thomas Zobel ◽  
C.-Thomas Bock ◽  
Uwe Kühl ◽  
Maria Rohde ◽  
Dirk Lassner ◽  
...  
Keyword(s):  
Parvovirus B19 ◽  
Single Gene ◽  
Antiviral Treatment ◽  
Symptomatic Treatment ◽  
Apoptosis Pathway ◽  
Circulating Angiogenic Cells ◽  
Endothelial Colony Forming Cells ◽  
Transcriptional Modulation ◽  
Induced Apoptosis

Aims: Human parvovirus B19 (B19V) infection directly induces apoptosis and modulates CXCR4 expression of infected marrow-derived circulating angiogenic cells (CACs). This leads to dysfunctional endogenous vascular repair. Treatment for B19V-associated disease is restricted to symptomatic treatment. Telbivudine, a thymidine analogue, established in antiviral treatment for chronic hepatitis B, modulates pathways that might influence induction of apoptosis. Therefore, we tested the hypothesis of whether telbivudine influences B19V-induced apoptosis of CAC. Methods and Results: Pretreatment of two CAC-lines, early outgrowth endothelial progenitor cells (eo-EPC) and endothelial colony-forming cells (ECFC) with telbivudine before in vitro infection with B19V significantly reduced active caspase-3 protein expression (−39% and −40%, both p < 0.005). Expression of Baculoviral Inhibitor of apoptosis Repeat-Containing protein 3 (BIRC3) was significantly downregulated by in vitro B19V infection in ECFC measured by qRT-PCR. BIRC3 downregulation was abrogated with telbivudine pretreatment (p < 0.001). This was confirmed by single gene PCR (p = 0.017) and Western blot analysis. In contrast, the missing effect of B19V on angiogenic gene expression postulates a post-transcriptional modulation of CXCR4. Conclusions: We for the first time show a treatment approach to reduce B19V-induced apoptosis. Telbivudine reverses B19V-induced dysregulation of BIRC3, thus, intervening in the apoptosis pathway and protecting susceptible cells from cell death. This approach could lead to an effective B19V treatment to reduce B19V-related disease.

scholarly journals Otolaryngic Manifestations of Cushing Disease

2017 ◽  
Vol 96 (8) ◽  
pp. E28-E30 ◽  
Author(s):  
Edward C. Kuan ◽  
Kevin A. Peng ◽  
Jeffrey D. Suh ◽  
Marvin Bergsneider ◽  
Marilene B. Wang
Keyword(s):  
Pituitary Adenoma ◽  
Cushing Syndrome ◽  
Medical Center ◽  
Academic Medical Center ◽  
Retrospective Chart Review ◽  
Signs And Symptoms ◽  
Cushing Disease ◽  
Comprehensive Management ◽  
Academic Medical ◽  
Obstructive Sleep

Cushing disease is a relatively rare cause of Cushing syndrome secondary to a hyperfunctioning pituitary adenoma. In addition to signs and symptoms of hypercortisolism, Cushing disease may present with diverse otolaryngic manifestations, which may guide diagnosis and management. We performed a retrospective chart review of patients who were found to have Cushing disease and who underwent transnasal transsphenoidal surgery for pituitary adenomas between January 1, 2007, and July 1, 2014, at a tertiary academic medical center. There were 37 consecutive patients in this series with Cushing disease caused by a pituitary adenoma. Fifteen (41%) patients complained of visual changes. Five (14%) patients suffered from obstructive sleep apnea. Four (11%) patients had thyroid disease. Other symptoms included hearing loss, vertigo, tinnitus, epistaxis, dysphagia, and salivary gland swelling. Although Cushing disease traditionally presents with classic “Cushingoid” systemic features, it also may present with various otolaryngic manifestations. A thorough workup by otolaryngologists is critical in the comprehensive management of these patients.

scholarly journals Should You Follow the Better-Hearing Ear for Congenital Cytomegalovirus Infection and Isolated Sensorineural Hearing Loss?

2019 ◽  
Vol 162 (1) ◽  
pp. 114-120 ◽  
Author(s):  
Vanessa Torrecillas ◽  
Chelsea M. Allen ◽  
Tom Greene ◽  
Albert Park ◽  
Winnie Chung ◽  
...  
Keyword(s):  
Hearing Loss ◽  
Sensorineural Hearing Loss ◽  
Early Onset ◽  
Medical Center ◽  
Antiviral Treatment ◽  
Sensorineural Hearing ◽  
Cmv Infection ◽  
Congenital Cytomegalovirus ◽  
Delayed Onset ◽  
Hearing Thresholds

Objective To describe the progression of sensorineural hearing loss (SNHL) in the better- and poorer-hearing ears in children with asymptomatic congenital cytomegalovirus (CMV) infection with isolated SNHL. Study Design Longitudinal prospective cohort study. Setting Tertiary medical center. Subjects and Methods We analyzed hearing thresholds of the better- and poorer-hearing ears of 16 CMV-infected patients with isolated congenital/early-onset or delayed-onset SNHL identified through hospital-based CMV screening of >30,000 newborns from 1982 to 1992. Results By 12 months of age, 4 of 7 patients with congenital/early-onset SNHL developed worsening thresholds in the poorer-hearing ear, and 1 had an improvement in the better-hearing ear. By 18 years of age, all 7 patients had worsening thresholds in the poorer-hearing ear and 3 patients had worsening thresholds in the better-hearing ear. Hearing loss first worsened at a mean age of 2 and 6 years in the poorer- and better-hearing ears, respectively. Nine patients were diagnosed with delayed-onset SNHL (mean age of 9 years vs 12 years for the poorer- and better-hearing ears), 6 of whom had worsening thresholds in the poorer-hearing ear and 1 in both ears. Conclusion In most children with congenital CMV infection and isolated SNHL, the poorer-hearing ear worsened earlier and more precipitously than the better-hearing ear. This study suggests that monitoring individual hearing thresholds in both ears is important for appropriate interventions and future evaluation of efficacy of antiviral treatment.

scholarly journals Symptomatic Treatment of Vascular Cognitive Impairment (STREAM-VCI): Protocol for a Cross-Over Trial (Preprint)

2017 ◽  
Author(s):  
Jolien Fleur Leijenaar ◽  
Geert Jan Groeneveld ◽  
Wiesje Maria van der Flier ◽  
Philip Scheltens ◽  
Erica Surya Klaassen ◽  
...  
Keyword(s):  
Cognitive Impairment ◽  
Functional Connectivity ◽  
Positive Response ◽  
Medical Center ◽  
Competent Authority ◽  
Executive Dysfunction ◽  
Symptomatic Treatment ◽  
Vascular Cognitive Impairment ◽  
Vascular Damage ◽  
Double Blind

BACKGROUND People with vascular cognitive impairment (VCI) constitute a clinically heterogeneous group, but previous symptomatic drug trials in VCI did not take this clinical heterogeneity into account. Executive dysfunction and memory impairment are the cognitive domains that are most frequently impaired in VCI, and these impairments are likely to reflect vascular damage to specific neurotransmitter systems, which opens the possibility for targeted symptomatic treatment directed at specific neurotransmitters. OBJECTIVE Here we describe the design of the “Symptomatic Treatment of Vascular Cognitive Impairment” (STREAM-VCI) trial. In this proof-of-concept study, we investigate whether people with VCI with executive dysfunction due to vascular damage to the monoaminergic neurotransmitter system differentially respond to a monoaminergic challenge, whereas people with VCI with memory dysfunction associated with vascular damage to the cholinergic system will in turn respond to a cholinergic challenge. METHODS The STREAM-VCI is a single center, double blind, three-way cross-over trial among 30 people with VCI, in which subjects received a single dose of galantamine, methylphenidate, or placebo on separate occasions. The most important inclusion criteria were a diagnosis of VCI with a Mini-Mental State Examination score of ≥16 and a Clinical Dementia Rating of 0.5-1.0. For each person, the challenges consisted of a single 16 mg dose of galantamine, 10 mg of methylphenidate, and placebo, in random order on three separate visits. Change in performance in executive functioning and memory was assessed directly after the challenge using standardized neuropsychological tests. We will correlate a positive response to the cholinergic and monoaminergic treatment with differences in structural and functional connectivity at baseline using structural magnetic resonance imaging (MRI), diffusion tension MRI, and resting-state functional MRI. RESULTS The protocol of this study is approved by the Medical Ethics Committee of VU University Medical Center and the competent authority. The first participant was enrolled in April 2014. In September 2017, enrolment for the study was completed. We expect to publish the results in 2018. CONCLUSIONS STREAM-VCI is the first study to investigate the association of a response to a cholinergic and monoaminergic treatment with structural and functional connectivity of the monoaminergic and/or cholinergic systems on MRI. We aim to predict on an individual basis which individuals show a positive response to a cholinergic and/or monoaminergic challenge in people with VCI. This may be instrumental in moving in the direction of individually-tailored pharmacological interventions based on MRI measures in people with VCI. CLINICALTRIAL ClinicalTrials.gov NCT02098824; https://clinicaltrials.gov/ct2/show/NCT02098824 (Archived by WebCite at http://www.webcitation.org/6xhO7Ya1q)

scholarly journals Echocardiography Abnormal Findings and Laboratory Operations during the COVID-19 Pandemic at a High Volume Center in New York City

Healthcare ◽  
2020 ◽  
Vol 8 (4) ◽  
pp. 534 ◽  
Author(s):  
Li Pang ◽  
Eric P. Stahl ◽  
Kana Fujikura ◽  
Michelle Chen ◽  
Weijia Li ◽  
...  
Keyword(s):  
New York ◽  
New York City ◽  
Cardiac Imaging ◽  
York City ◽  
Medical Center ◽  
Systolic Pressure ◽  
High Volume ◽  
Management Approach ◽  
Imaging Studies ◽  
Ventricular Systolic Pressure

(1) Background: This study sought to explore how the novel coronavirus (COVID-19) pandemic affected the echocardiography (TTE) laboratory operations at a high volume medical center in New York City. Changes in cardiac imaging study volume, turn-around time, and abnormal findings were analyzed and compared to a pre-pandemic period. (2) Methods: Volume of all cardiac imaging studies and TTE reports between 11 March 2020 to 5 May 2020 and the same calendar period in 2019 were retrospectively identified and compared. (3) Results: During the pandemic, our center experienced a 46.72% reduction in TTEs, 82.47% reduction in transesophageal echocardiograms, 83.16% reduction in stress echo, 70.32% reduction in nuclear tests, 46.25% reduction in calcium score, 73.91% reduction in coronary computed tomography angiography, and 87.23% reduction in cardiac magnetic resonance imaging. TTE findings were overall similar between 2020 and 2019 (all p ≥ 0.05), except for a significantly higher right ventricular systolic pressure in 2020 (39.8 ± 14.2 vs. 34.6 ± 11.2 mmHg, p = 0.012). (4) Conclusions: Despite encountering an influx of critically ill patients, our hospital center experienced a reduction in the number of cardiac imaging studies, which likely represents a change in both patient mindset and physician management approach.

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