scholarly journals Prophylactic role of ivermectin in SARS-CoV-2 infection among healthcare workers

2021 ◽  
Author(s):  
Priyamadhaba Behera ◽  
Binod Kumar Patro ◽  
Biswa Mohan Padhy ◽  
Prasanta Raghab Mohapatra ◽  
Shakti Kumar Bal ◽  
...  
Keyword(s):  
Lower Risk ◽  
Healthcare Workers ◽  
Absolute Risk ◽  
Low Cost ◽  
Absolute Risk Reduction ◽  
Healthcare Services ◽  
Adjusted Relative Risk ◽  
Kaplan Meier

Abstract Background Healthcare workers (HCWs) are vulnerable to getting infected withSARS-CoV-2. Preventing HCWs from getting infected is a priority to maintain healthcare services. The therapeutic and preventive role of ivermectin in COVID-19 is being investigated. Based on promising results of in vitro studies of oral ivermectin, this study was conducted with the aim to demonstrate the prophylactic role of oral ivermectin in preventing SARS-CoV-2 infectionamong HCWs at All India Institute of Medical Sciences (AIIMS), Bhubaneswar.Methods A prospective cohort study was conducted at AIIMS Bhubaneswar, which provides both COVID and Non-COVID care since March 2020. All employees and students of the institute who provided written informed consent participated in the study.Uptake of two-doses of oral ivermectin (300 μg/kg at a gap of 72 hours) was considered as exposure. The primary outcome of the study was COVID-19 infection in the following month of ivermectin consumption diagnosed by RTPCR as per Government of India testing criteria guidelines.The log-binomial model was used to estimate adjusted relative risk, and the Kaplan-Meier failure plot was used to estimate the probability of COVID-19 infection with follow-up time.Results Of 3892 employees, 3532 (90.8%) participated in the study. The ivermectin uptake was 62.5% and 5.3% for two-doses and single-dose, respectively. Participants who took ivermectin prophylaxis had a lower risk of getting symptoms suggestive of SARS-CoV-2 infection(6% vs 15%). HCWs who had taken two-doses of oral ivermectin have a significantly lower risk of contracting COVID-19 disease during the following month (ARR 0.17; 95% CI, 0.12-0.23). Females had a lower risk of contracting COVID-19 than males (ARR 0.70 95% CI, 0.52-0.93). The absolute risk reduction of SARS-CoV-2 infection was 9.7%. Only 1.8% of the participants reported adverse events, which were mild and self-limiting.Conclusion and relevance Two-doses of oral ivermectin (300 μg/kg given 72 hours apart) as chemoprophylaxis among HCWs reduces the risk of COVID-19 infection by 83% in the following month. Safe, effective, and low-cost chemoprophylaxis have relevance in the containment of pandemic alongside vaccine.

scholarly journals OP0240 EPIDEMIOLOGY, PREDICTORS OF MORTALITY AND ROLE OF PROPHYLAXIS FOR PNEUMOCYSTITIS JIROVECI PNEUMONIA AMONG RHEUMATIC PATIENTS: A TERRITORY-WIDE STUDY

2021 ◽  
Vol 80 (Suppl 1) ◽  
pp. 147-147
Author(s):  
C. W. S. Chan ◽  
H. Y. Chung ◽  
W. Y. Yeung ◽  
C. S. Lau ◽  
P. H. LI
Keyword(s):  
Lupus Erythematosus ◽  
Absolute Risk ◽  
Absolute Risk Reduction ◽  
Number Needed To Treat ◽  
Healthcare Database ◽  
Pneumocystis Jiroveci ◽  
Predictors Of Mortality ◽  
Prednisolone Dose ◽  
Rheumatic Patients

Background:Pneumocystis jiroveci pneumonia (PJP) is an opportunistic infection affecting immunocompromised individuals. Due to its high mortality, PJP prophylaxis is commonly recommended for many immunocompromising conditions. However, evidence regarding the burden and role of prophylaxis in PJP among rheumatic patients remains limited. There is lack of consensus for when and for whom to initiate prophylaxis. Delineating the epidemiology, predictors of mortality and efficacy of prophylaxis in PJP among rheumatic patients is urgently needed.Objectives:To delineate the epidemiology of PJP, identify predictors of mortality and evaluate the usefulness of prophylaxis in rheumatology patients.Methods:We performed a big-data cohort study based on the territory-wide healthcare database of the Hong Kong Hospital Authority. All patients with a diagnosis of anti-neutrophil cytoplasmic antibody-associated vasculitis (AAV), immune-mediated myositis (IMM), rheumatoid arthritis (RA), systemic lupus erythematosus (SLE), systemic sclerosis (SSc), or spondyloarthritis (SpA) between 2015-2019 were included. PJP were identified based on physician diagnosis and/or positive microbiological results from deep respiratory tract specimens. Prophylaxis was defined as prescription of a prophylactic dose of co-trimoxazole for at least 2 weeks and/or inhaled pentamidine. Prevalence of PJP, prophylaxis and mortality among rheumatic patients were calculated. Demographics, blood parameters and immunosuppressants use was also collected for multivariate analysis. Number needed to treat (NNT) analysis was performed based on absolute risk reduction of PJP in patients with and without prior PJP prophylaxis.Results:A total of 21,587 unique rheumatic patients were analysed (54% RA, 25% SLE, 13% SpA, 5% IMM, 2% AAV and 1% SSc). Between 2015-2019, 1141 (5.3%) patients were prescribed PJP prophylaxis and 48 (0.2%) developed PJP. None of those patients who developed PJP had received prophylaxis prior to infection. The risk of PJP was highest among SSc (1.8%), AAV (1.4%) and IMM (0.7%) patients, with NNT of SSc 36, AAV 48 and IMM 114. Within these disease entities, the majority of PJP occurred at prednisolone dose of 15mg/day (P15) or above (100% in SSc and IIM, 66.7% in AAV). Overall, PJP was associated with a mortality-rate of 39.6%. Glucocorticoid dose (daily prednisolone dose equivalent 29.1±23.5mg vs 11.4±7.2mg, P<0.01) and lymphopenia (0.44x109/L vs 0.90x109/L, P= 0.04) at PJP diagnosis were associated with PJP mortality in rheumatic patients.Conclusion:PJP is an uncommon but important infection in rheumatic patients associated with significant mortality. PJP prophylaxis is effective and should be considered in patients with SSc, AAV and IMM, especially in those receiving a steroid dose above P15.Disclosure of Interests:None declared

scholarly journals Design and Adoption of Low-Cost Point-of-Care Diagnostic Devices: Syrian Case

Micromachines ◽  
2021 ◽  
Vol 12 (8) ◽  
pp. 882
Author(s):  
M. Munzer Alseed ◽  
Hamzah Syed ◽  
Mehmet Cengiz Onbasli ◽  
Ali K. Yetisen ◽  
Savas Tasoglu
Keyword(s):  
Civil Wars ◽  
Healthcare Workers ◽  
New Technologies ◽  
Point Of Care ◽  
Low Cost ◽  
Healthcare Services ◽  
Efficient Solutions ◽  
Humanitarian Crises ◽  
Technology Experience ◽  
The Cost

Civil wars produce immense humanitarian crises, causing millions of individuals to seek refuge in other countries. The rate of disease prevalence has inclined among the refugees, increasing the cost of healthcare. Complex medical conditions and high numbers of patients at healthcare centers overwhelm the healthcare system and delay diagnosis and treatment. Point-of-care (PoC) testing can provide efficient solutions to high equipment cost, late diagnosis, and low accessibility of healthcare services. However, the development of PoC devices in developing countries is challenged by several barriers. Such PoC devices may not be adopted due to prejudices about new technologies and the need for special training to use some of these devices. Here, we investigated the concerns of end users regarding PoC devices by surveying healthcare workers and doctors. The tendency to adopt PoC device changes is based on demographic factors such as work sector, education, and technology experience. The most apparent concern about PoC devices was issues regarding low accuracy, according to the surveyed clinicians.

scholarly journals To Volunteer or Not? Perspectives towards Pre-Registered Nursing Students Volunteering Frontline during COVID-19 Pandemic to Ease Healthcare Workforce: A Qualitative Study

2021 ◽  
Vol 18 (12) ◽  
pp. 6668
Author(s):  
Betsy Seah ◽  
Ben Ho ◽  
Sok Ying Liaw ◽  
Emily Neo Kim Ang ◽  
Siew Tiang Lau
Keyword(s):  
Nursing Students ◽  
Qualitative Study ◽  
Professional Identity ◽  
Healthcare Workers ◽  
Healthcare Services ◽  
Strategic Partnerships ◽  
Healthcare Workforce ◽  
Student Volunteer ◽  
Operational Processes

COVID-19 has caused a shortage of healthcare workers and has strained healthcare systems globally. Pre-registered healthcare students with training have a duty of care and can support the healthcare workforce. This study explored factors influencing the willingness of final-year nursing students to volunteer during the COVID-19 pandemic, the role of professional identity in volunteering as healthcare workers, and strategies to improve future volunteering uptakes and processes. A qualitative study using focus-group discussions was conducted. Final-year nursing students who volunteered, students who did not volunteer, and lecturers who supervised student volunteers were recruited. Interviews were conducted online, video-recorded, and transcribed verbatim. A thematic analysis was used. The themes were “wavering thoughts on volunteering”, “bringing out ‘the nurse’ in students through volunteering” and “gearing up to volunteer”. Findings suggested the need to look beyond the simplicity of altruism to the role of professional identity, operational, and motivational factors to explain nursing students’ decision to volunteer and their volunteer behavior. Providing accommodation, monetary and academic-related incentives, supporting the transitionary phase from students to “professional volunteers”, promoting cohesive and positive staff–student volunteer relationships, and establishing a volunteer management team are strategies identified to improve volunteering uptake and operational processes. Our findings advocate strategic partnerships between hospitals/communities and academic institutions in providing various healthcare services during pandemics.

scholarly journals Elevated FOXC2 Expression Promotes Invasion of HCC Cell Lines and is Associated with Poor Prognosis in Hepatocellular Carcinoma

2017 ◽  
Vol 44 (1) ◽  
pp. 99-109 ◽  
Author(s):  
Fang Yang ◽  
Lizhi Lv ◽  
Kun Zhang ◽  
Qiucheng Cai ◽  
Jianyong Liu ◽  
...  
Keyword(s):  
Hepatocellular Carcinoma ◽  
Flow Cytometric Analysis ◽  
Vital Role ◽  
Migration And Invasion ◽  
Flow Cytometric ◽  
Kaplan Meier ◽  
Proliferation Assays ◽  
The Relationship

Background/Aims: Increasing evidence has indicated that Forkhead box protein C2 (FOXC2) plays an important role in carcinogenesis. However, the expression and the role of FOXC2 in hepatocellular carcinoma (HCC) have not been extensively studied. Methods: FOXC2 expression was analyzed by quantitative real-time polymerase chain reaction, Western blot analysis and immunohistochemistry in HCC tissue and cells. The relationship between FOXC2 expression and patient clinical significance and survival were assessed by Pearson’s correlation and Kaplan-Meier analysis, respectively. Cell proliferation assays, colony formation assays, flow cytometric analysis and Transwell assays were employed to measure the effects of FOXC2 on HCC cells in vitro. Results: The expression of FOXC2 was increased in HCC tissue, and high FOXC2 expression was associated with worse patient survival. Knockdown of FOXC2 inhibited HCC cell growth, migration, and invasion in vitro, as well as tumor growth. Furthermore, we found that activation of AKT-mediated MMP-2 and MMP-9 was involved in FOXC2 promoting an aggressive phenotype. Conclusions: Taken together, these findings demonstrate that FOXC2 is upregulated in HCC tissue and is associated with tumor size, vascular invasion and advanced TNM stage. Further investigation suggested that FOXC2 may play a vital role in promoting proliferation and invasion in HCC and serves as a novel therapeutic target in HCC.

scholarly journals Role of primary healthcare in the response to COVID-19: The Oman experience

2021 ◽  
Vol 2021 (1) ◽  
Author(s):  
Badria Al Rashidi ◽  
Ahmed H. Al Wahaibi ◽  
Ozayr Mahomed ◽  
Sitwat Usman Langrial ◽  
Salah T. Al Awaidy
Keyword(s):  
Primary Healthcare ◽  
Healthcare Workers ◽  
Healthcare Services ◽  
Care Staff ◽  
Outpatient Services ◽  
Efficient Manner ◽  
Health Authorities ◽  
Time Period ◽  
Rehabilitative Services

Health authorities are focused on swiftly alleviating the spread of COVID-19 infections to support the overburdened healthcare system and reduce the mortality rates associated with the ongoing pandemic. Across Oman, there are 243 primary healthcare (PHC) clinics that act as the first point of contact for providing a comprehensive range of healthcare services. Further, they provide access to more than 30 programs that are delivered by well-trained primary care staff from different categories. PHCs adopted the strategy of providing healthcare services directly related to positive COVID-19 cases, preventing the likely spread of COVID-19 infection among healthcare workers, and reducing the spread of COVID-19 in the community. This review outlines four major challenges that were observed and informally reported by the healthcare workers at PHCs in Oman from January to December 2020. Understanding the nature of these challenges can help health authorities in preparing effectively for any future viral outbreaks and mitigating them in a timely and efficient manner. One of the major challenges faced by PHCs was the reduction in outpatient services from January to December 2020 in comparison with the same time period in the last year. PHCs addressed the main health problems in the community through health promotion, as well as preventive, curative, and rehabilitative services under unusual circumstances. However, there is a need for a modified approach during circumstances such as the COVID-19 pandemic. This will help us cope with possible future viral outbreaks in a better manner.

scholarly journals PLOD1 Is a Prognostic Biomarker and Mediator of Proliferation and Invasion in Osteosarcoma

2020 ◽  
Vol 2020 ◽  
pp. 1-12
Author(s):  
Haoli Jiang ◽  
Wei Guo ◽  
Shanyou Yuan ◽  
Lixia Song
Keyword(s):  
Survival Analysis ◽  
Expression Pattern ◽  
Migration And Invasion ◽  
Western Blots ◽  
Primary Bone Tumor ◽  
Kaplan Meier ◽  
The Status ◽  
Public Datasets

Objective. Osteosarcoma is the most common primary bone tumor and most frequently develops during adolescence. PLOD family was mainly involved in lysyl hydroxylation and rarely investigated in cancers, especially in osteosarcoma. The aim of this study was to investigate the expression pattern and oncogenic role of PLODs in osteosarcoma. Methods. GEO datasets (GSE16088, GSE33382, and GSE16091) and validation cohort were used to analyze the expression pattern of PLODs in osteosarcoma. Kaplan-Meier survival analysis was used to explore the prognostic role of PLODs in patients with osteosarcoma. RNA interference of KRT19 was performed using small interfering RNA (siRNA) in MG-63 and U-2OS cells. The proliferation was detected using CCK8, clone formation assay, and EdU staining. Migration and invasion were determined using the transwell assay. Western blots and luciferase assays for β-catenin-T-cell factor protein/β-catenin-lymphoid enhancer factor- (β-catenin-TCF/LEF-) driven transcriptional activity. Results. PLOD1 was upregulated in osteosarcoma tissues compared with control tissues both in public datasets and in in-house cohort. The expression of PLOD1 in osteosarcoma tissues was significantly associated with the status of distance metastasis and Enneking stage, while PLOD2 and PLOD3 expressed no difference between osteosarcoma and benign tissues and showed no correlation with tumor malignancy. Furthermore, Kaplan-Meier survival analysis revealed that patients with a higher level of PLOD1 had worse prognosis than those with a lower level of PLOD1. Downregulation of PLOD1 dramatically inhibited proliferation, migration, and invasion of MG-63 cells and U-2OS cells in vitro. Mechanistically, PLOD1 regulated β-catenin signaling pathway in osteosarcoma. Conclusion. Our results indicated that PLOD1 promoted proliferation, migration, and invasion of osteosarcoma cells. PLOD1 was a novel prognostic marker, as well as a therapeutic target in osteosarcoma.

Interpreting survival outcomes for African-American (AA) patients (pts) with metastatic castration-resistant prostate cancer (mCRPC) treated with sipuleucel-T (SIP-T) with number needed to treat to benefit (NNTB).

2019 ◽  
Vol 37 (7_suppl) ◽  
pp. 222-222
Author(s):  
Kelvin A. Moses ◽  
Scott C. Flanders ◽  
Matthew Harmon ◽  
Nancy N. Chang ◽  
Walter Rayford ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Absolute Risk ◽  
Performance Status ◽  
Absolute Risk Reduction ◽  
Phase Iii ◽  
Cellular Immunotherapy ◽  
Number Needed To Treat ◽  
Castration Resistant Prostate Cancer ◽  
Kaplan Meier ◽  
Receive Treatment

222 Background: AA men often present with more aggressive prostate cancer and are less likely to receive treatment, negatively affecting quality-of-life and overall survival (OS). Sipuleucel-T is an autologous cellular immunotherapy approved for asymptomatic or minimally symptomatic mCRPC. Data from the PROCEED registry showed that OS for AA pts treated with SIP-T was 9.3 mo longer than OS for Caucasian pts. In a prior subgroup analysis of Phase III data, AA pts realized a 30.7-mo difference in OS with SIP-T vs. placebo (PBO). We calculated the NNTB to further interpret the OS benefit in AA pts. Methods: Data were pooled from 3 Phase III mCRPC SIP-T trials (D9901, D9902A, and IMPACT). The absolute risk reduction (ARR) is calculated from Kaplan-Meier estimates at 12-, 24-, and 36-mo for all SIP-T subjects, and an AA cohort, receiving ≥1 infusion. NNTB, the inverse of the ARR, represents the number of pts needed to be treated with SIP-T to prevent 1 additional death compared to PBO. All NNTB values are rounded up. Results: Of the 737 pooled mCRPC pts enrolled, 488 men were randomized to SIP-T (n=33 AA), and 249 to PBO. Baseline clinical characteristics between the SIP-T and PBO groups were well balanced; however, compared to overall SIP-T and PBO, AA SIP-T pts were more likely to have received prior chemotherapy, lower hemoglobin, and better performance status. The NNTB at 12-mo was the same (13) for both the pooled SIP-T and AA treated cohort. At 24-mo, the NNTB values were 10 for pooled and 5 for AA. At 36-mo, an NNTB of 8 (pooled) and 3 (AA) SIP-T treatments prevented 1 additional death (Table). Conclusions: This NNTB analysis shows a favorable survival benefit for AA men treated with SIP-T and all treated SIP-T subjects. NNTB values declined over 3-years, suggesting durability of clinical benefit with SIP-T, and that it may address a known survival disparity in AA with prostate cancer. Studies with larger sample sizes may confirm if AA pts derive a greater OS benefit from SIP-T. Clinical trial information: NCT00065442. [Table: see text]

Abstract 13117: Incorporation of High-Sensitivity Troponin Along With the AHA/ACC Cholesterol Guidelines for Improved Risk Stratification and Targeted PCSK9 Inhibition in Atherosclerotic Cardiovascular Disease

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Nicholas A Marston ◽  
Kazuma Oyama ◽  
Minao Tang ◽  
Petr Jarolim ◽  
Peter S Sever ◽  
...  
Keyword(s):  
High Risk ◽  
Risk Reduction ◽  
Lower Risk ◽  
Absolute Risk ◽  
High Sensitivity ◽  
Absolute Risk Reduction ◽  
Pcsk9 Inhibitors ◽  
High Sensitivity Troponin ◽  
Cholesterol Guidelines ◽  
Very High

Introduction: The 2018 AHA/ACC cholesterol guidelines only recommend PCSK9 inhibitors in patients with very high risk ASCVD. However, high-sensitivity troponin (hsTn) can reclassify some lower risk patients as very high risk, identifying a subgroup who may benefit from PCSK9 inhibitors. Methods: We performed a nested prospective biomarker substudy including 22,224 patients enrolled in the FOURIER trial, which tested the PCSK9 inhibitor evolocumab. Per the guidelines, patients were assigned to ASCVD risk categories of “very high risk” or “not very high risk” (lower risk), followed by classification based on hsTnI (Abbott ARCHITECT) using an a priori risk threshold of 6 ng/L. The primary endpoint was a composite of CV death, MI, stroke, unstable angina, or coronary revascularization. The median follow-up was 2.2 years. Results: Clinical ASCVD categories alone identified a gradient of risk from 7.1% to 12.3% (HR 1.83, p<0.0001). Adding hsTnI further risk stratified patients by 1.5- to 2-fold in both the lower and very high risk ASCVD categories (HR 1.73, p=0.017 & HR 1.81, P<0.0001). Among patients with lower risk ASCVD, 25% had an elevated hsTnI and carried a similar risk (10.5%) to patients with very high risk ASCVD and low hsTnI (9.8%). Very high risk ASCVD patients receiving evolocumab had an absolute risk reduction of 1.9% (0.98-2.72). A similar absolute risk reduction was seen in the 25% of patients in the lower risk group with elevated hsTnI (ARR 2.0%, Figure). Conclusions: Either hsTn or ASCVD clinical criteria can identify patients who benefit from evolocumab. Specifically, hsTnI identifies a significant cohort of nominally lower risk ASCVD patients who are actually at greater risk than appreciated and may derive absolute risk reductions on par with very high risk ASCVD patients.

scholarly journals XAGE-1b Promotes the Proliferation, Invasion and Metastasis of Gastric Cancer

2020 ◽  
Author(s):  
Hui Men ◽  
Zhi-wei Zhang ◽  
Gui-feng Lu ◽  
Shun Tan ◽  
Wen-Hui Hu ◽  
...  
Keyword(s):  
Gastric Cancer ◽  
Malignant Tumors ◽  
Survival Curve ◽  
Biological Marker ◽  
Invasion And Metastasis ◽  
Treatment Target ◽  
Kaplan Meier ◽  
Proliferation And Invasion

Abstract Background X antigen family member 1B (XAGE-1b), a member of XAGE subfamily and GAGE family, is upregulated in some malignant tumors and has been associated with the proliferation, invasion and metastasis of tumors. However, the biological roles of XAGE-1b in gastric cancer (GC) still remain unclear. Methods We detected the expression of XAGE-1b in 60 paired fresh tissues of GC patients by real-time RT-PCR. Kaplan-Meier survival curve was explored to analyze 5-year survival time of GC patients. Function experiments were performed to estimate the role of XAGE-1b on the proliferation, invasion and metastasis of GC cells. Informatic analysis was applied to investigate the potential mechanisms. Results XAGE-1b was obviously upregulated in GC tissues. XAGE-1b was correlated significantly with poor prognosis of GC patients. XAGE-1b markedly promoted the proliferation and invasion in GC cell lines in vitro. Knockdown of XAGE-1b promoted the pulmonary metastatic ability in nude mice. Moreover, XAGE-1b was positively or negatively correlated with the expression of CLDN6 and CHGA, which regulated the progression of GC. Conclusions XAGE-1b could act as an oncogene in GC, which provides a potential biological marker or treatment target for GC.

Health Care Problems and Ensuring Sustainable Development among Employees

2020 ◽  
Vol 57 (3) ◽  
Author(s):  
Tomasz Rostkowski
Keyword(s):  
Sustainable Development ◽  
Healthcare System ◽  
Healthcare Workers ◽  
Scientific Information ◽  
Healthcare Services ◽  
The Republic ◽  
Care Problems ◽  
Diverse Data ◽  
Medical Healthcare

The article offers a synthetic presentation of the results of analyses of diverse data resources and other scientific information concerning the healthcare in Poland. These studies were conducted in order to put forward positive changes that are not only to prevent the fall of the system, which is highly probable, but also to improve the availability of medical services and increase their quality. These studies are of major importance because the availability of medical (healthcare) services is largely determined by whether it is possible to implement the idea of sustainable development among employees, which indirectly determines the possibility of implementing sustainable development principles incorporated into legal circulation under one of the first articles of the Constitution of the Republic of Poland. The concept of sustainable development is not only one of the important reasons which call for modernisation of the functioning of the healthcare system, but also an idea which, once applied, may be helpful in solving healthcare problems. Considering the fact that the largest problem of this system in Poland lies in the shortage of employees, it becomes clear that by trying to ensure sustainable development of employees working in other industries, first, it is necessary to take care of their health, which must lead through sustainable development of healthcare workers. The aim of the article is to present the comprehensive nature of the idea of sustainable development of employees, the role of health protection in achieving a balance by employees, and to show the way to build integrated programmes to maintain the health of employees and their families against the background of the limitations of the Polish healthcare system.

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