scholarly journals Nitazoxanide against COVID-19 in three explorative scenarios

2020 ◽  
Vol 14 (09) ◽  
pp. 982-986
Author(s):  
José Meneses Calderón ◽  
Ma. del Rocío Figueroa Flores ◽  
Leopoldo Paniagua Coria ◽  
Jesús Carlos Briones Garduño ◽  
Jazmín Meneses Figueroa ◽  
...  
Keyword(s):  
Internal Medicine ◽  
Positive Outcome ◽  
Hospitalized Patients ◽  
Ambulatory Setting ◽  
Medical Attention ◽  
Clinical Settings ◽  
Medicine Service ◽  
Ambulatory Patients

Introduction: Nitazoxanide has shown efficacy in vitro against coronavirus infections (MERS, SARS, SARS-CoV-2). The aim of this report is to describe the results of treating COVID-19 positive patients with nitazoxanide in three clinical settings: pregnancy/puerperium, hospitalized patients in an Internal Medicine Service and in an ambulatory setting. Methodology: This was a prospective follow-up and report of COVID-19 cases in three different situations, pregnant women, hospitalized patients receiving medical attention in an Internal Medicine Service and ambulatory patients residing in Toluca City, and Mexico City. Results: The experience with a first group of 20 women, pregnant (17) or in immediate puerperium (3) was successful in 18 cases with two unfortunate deaths. The five cases treated in an Internal Medicine service showed a positive outcome with two patients weaned from mechanical ventilation. Of the remaining 16 patients treated in an ambulatory setting, all got cured. Nitazoxanide seems to be useful against SARS-CoV-2, not only in an early intervention but also in critical condition as well as in pregnancy without undesired effects for the babies. As an adjunctive therapy budesonide was used that seems to contribute to the clinical improvement. Conclusions: Nitazoxanide could be useful against COVID-19 as a safe and available regimen to be tested in a massive way immediately.

scholarly journals Perception of usefulness of laboratory tests ordering by internal medicine residents in ambulatory setting: A single-center prospective cohort study

PLoS ONE ◽  
2021 ◽  
Vol 16 (5) ◽  
pp. e0250769
Author(s):  
Dimitria Doi ◽  
Romulo Ribeiro do Vale ◽  
Jean Michell Correia Monteiro ◽  
Glauco Cabral Marinho Plens ◽  
Mario Ferreira Junior ◽  
...  
Keyword(s):  
Internal Medicine ◽  
Laboratory Tests ◽  
Medical Training ◽  
Outpatient Service ◽  
Ambulatory Setting ◽  
Subjective Perception ◽  
Internal Medicine Residents ◽  
Co Morbidity ◽  
Test Ordering

The demand for high value health care uncovered a steady trend in laboratory tests ordering and inappropriate testing practices. Residents’ training in laboratory ordering practice provides an opportunity for quality improvement. We collected information on demographics, the main reason for the appointment, preexisting medical conditions and presence of co-morbidities from first-visit patients to the internal medicine outpatient service of our university general hospital. We also collected information on all laboratory tests ordered by the attending medical residents. At a follow-up visit, we recorded residents’ subjective perception on the usefulness of each ordered laboratory test for the purposes of diagnosis, prognosis, treatment or screening. We observed that 17.3% of all ordered tests had no perceived utility by the attending resident. Tests were usually ordered to exclude differential diagnoses (26.7%) and to help prognosis estimation (19.1%). Age and co-morbidity influenced the chosen category to legitimate usefulness of tests ordering. This study suggests that clinical objectives (diagnosis, prognosis, treatment or prevention) as well as personalization to age and previous health conditions should be considered before test ordering to allow a more appropriate laboratory tests ordering, but further studies are necessary to examine this framework beyond this medical training scenario.

scholarly journals Hypokalemia: a clinical update

2018 ◽  
Vol 7 (4) ◽  
pp. R135-R146 ◽  
Author(s):  
Efstratios Kardalas ◽  
Stavroula A Paschou ◽  
Panagiotis Anagnostis ◽  
Giovanna Muscogiuri ◽  
Gerasimos Siasos ◽  
...  
Keyword(s):  
Hospitalized Patients ◽  
Medical Attention ◽  
Electrolyte Disturbance ◽  
Potassium Homeostasis ◽  
Practical Algorithms ◽  
Appropriate Treatment ◽  
Individualized Approach

Hypokalemia is a common electrolyte disturbance, especially in hospitalized patients. It can have various causes, including endocrine ones. Sometimes, hypokalemia requires urgent medical attention. The aim of this review is to present updated information regarding: (1) the definition and prevalence of hypokalemia, (2) the physiology of potassium homeostasis, (3) the various causes leading to hypokalemia, (4) the diagnostic steps for the assessment of hypokalemia and (5) the appropriate treatment of hypokalemia depending on the cause. Practical algorithms for the optimal diagnostic, treatment and follow-up strategy are presented, while an individualized approach is emphasized.

scholarly journals Prevalence of delirium in hospitalized patients from an internal medicine service

Medwave ◽  
2015 ◽  
Vol 15 (10) ◽  
pp. e6311-e6311 ◽  
Author(s):  
Ana Carolina González Pezoa ◽  
Bernardita Claudia Carrillo Venezian ◽  
Sandra Castillo Rojas
Keyword(s):  
Internal Medicine ◽  
Hospitalized Patients ◽  
Medicine Service

scholarly journals Prevalence and Causes of Anemia in Hospitalized Patients: Impact on Diseases Outcome

2020 ◽  
Vol 9 (4) ◽  
pp. 950 ◽  
Author(s):  
Maria Luigia Randi ◽  
Irene Bertozzi ◽  
Claudia Santarossa ◽  
Elisabetta Cosi ◽  
Fabrizio Lucente ◽  
...  
Keyword(s):  
Internal Medicine ◽  
Folic Acid ◽  
Vitamin B12 ◽  
Inflammatory Diseases ◽  
Specific Treatment ◽  
Hospitalized Patients ◽  
Medical Attention ◽  
Loss Of Function ◽  
Discharge Letter ◽  
A Minor

Anemia is extremely common in hospitalized patients who are old and often with multiple diseases. We evaluated 435 consecutive patients admitted in the internal medicine department of a hub hospital and 191 (43.9%) of them were anemic. Demographic, historic and clinical data, laboratory tests, duration of hospitalization, re-admission at 30 days and death were recorded. Patients were stratified by age (<65, 65–80, >80 years), anemia severity, and etiology of anemia. The causes of anemia were: iron deficiency in 28 patients, vitamin B12 and folic acid deficiencies in 6, chronic inflammatory diseases in 80, chronic kidney disease in 15, and multifactorial in 62. The severity of the clinical picture at admission was significantly worse (p < 0.001), length of hospitalization was longer (p < 0.001) and inversely correlated to the Hb concentration, re-admissions and deaths were more frequent (p 0.017) in anemic compared to non-anemic patients. A specific treatment for anemia was used in 99 patients (36.6%) (transfusions, erythropoietin, iron, vitamin B12 and/or folic acid). Anemia (and/or its treatment) was red in the discharge letter only 54 patients. Even if anemia is common, in internal medicine departments scarce attention is paid to it, as it is generally considered a “minor” problem, particularly in older patients often affected by multiple pathologies. Our data indicate the need of renewed medical attention to anemia, as it may positively affect the outcome of several concurrent medical conditions and the multidimensional loss of function in older hospitalized patients.

scholarly journals Variables associated with frailty in a hospital population in Colombia

2020 ◽  
Vol 14 (2) ◽  
pp. 114-119
Author(s):  
Diego Moreno Díaz ◽  
Andrés Ochoa ◽  
Mario Alberto Corzo ◽  
Miguel Cadena Sanabria ◽  
Claudia Lucía Figueroa
Keyword(s):  
Functional Decline ◽  
Predictive Ability ◽  
Cross Sectional Study ◽  
Hospitalized Patients ◽  
Adverse Outcomes ◽  
Cross Sectional ◽  
Medicine Service ◽  
Measurement Tools ◽  
Hospitalized Older Adults

INTRODUCTION: Frailty predicts functional decline and could be associated with adverse outcomes such as disability, multiple hospitalizations, falls, loss of mobility, and cardiovascular disease. In Colombia 12.5% of prevalence has been reported. In the present study, the different clinical variables associated with frailty were evaluated in a population of hospitalized patients older than 65 years in Bucaramanga, Colombia, in order to predict the behavior of these variables to generate measurement tools of greater applicability than that of currently existing tools. METHODS: An analytical observational cross-sectional study with nonprobabilistic sampling was conducted from January 2016 to June 2017 in patients older than 65 years of follow-up > 48 hours by the internal medicine service. Fried criteria were used to evaluate patients on their last day of hospitalization. RESULTS: A total of 155 patients were included, of whom 60.6% were frail. A combined analysis of the variables that showed association with frailty revealed that a calf circumference lower than or equal to 31 cm, a gait speed lower than or equal to 0.8 m/s, and age above 75 years were associated with frailty. It was also shown that being male and having a BMI > 27 kg/m2 are protective factors for frailty. CONCLUSIONS: The prevalence of frailty in hospitalized older adults was higher than that reported in local studies for the community population. According to multivariate analysis, the variables, when analyzed together, have a predictive ability of 92% to estimate frailty in hospitalized patients.

scholarly journals Kidney allograft recipients, immunosuppression, and coronavirus disease-2019: a report of consecutive cases from a New York City transplant center

2020 ◽  
Vol 35 (7) ◽  
pp. 1250-1261 ◽  
Author(s):  
Michelle Lubetzky ◽  
Meredith J Aull ◽  
Rebecca Craig-Schapiro ◽  
John R Lee ◽  
Jehona Marku-Podvorica ◽  
...  
Keyword(s):  
Graft Failure ◽  
Case Fatality Rate ◽  
Case Fatality ◽  
Hospitalized Patients ◽  
Adverse Outcomes ◽  
Ambulatory Setting ◽  
Kidney Graft ◽  
Fatality Rate ◽  
Early Management ◽  
Ambulatory Patients

Abstract Background Kidney graft recipients receiving immunosuppressive therapy may be at heightened risk for coronavirus disease 2019 (Covid-19) and adverse outcomes. It is therefore important to characterize the clinical course and outcome of Covid-19 in this population and identify safe therapeutic strategies. Methods We performed a retrospective chart review of 73 adult kidney graft recipients evaluated for Covid-19 from 13 March to 20 April 2020. Primary outcomes included recovery from symptoms, acute kidney injury, graft failure and case fatality rate. Results Of the 73 patients screened, 54 tested positive for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)—39 with moderate to severe symptoms requiring hospital admission and 15 with mild symptoms managed in the ambulatory setting. Hospitalized patients were more likely to be male, of Hispanic ethnicity and to have cardiovascular disease. In the hospitalized group, tacrolimus dosage was reduced in 46% of patients and mycophenolate mofetil (MMF) therapy was stopped in 61% of patients. None of the ambulatory patients had tacrolimus reduction or discontinuation of MMF. Azithromycin or doxycycline was prescribed at a similar rate among hospitalized and ambulatory patients (38% versus 40%). Hydroxychloroquine was prescribed in 79% of hospitalized patients. Graft failure requiring hemodialysis occurred in 3 of 39 hospitalized patients (8%) and 7 patients died, resulting in a case fatality rate of 13% among Covid-19-positive patients and 18% among hospitalized Covid-19-positive patients. Conclusions Data from our study suggest that a strategy of systematic triage to outpatient or inpatient care, early management of concurrent bacterial infections and judicious adjustment of immunosuppressive drugs rather than cessation is feasible in kidney transplant recipients with Covid-19.

scholarly journals A Resident-Led Intervention to Increase Initiation of Buprenorphine Maintenance for Hospitalized Patients With Opioid Use Disorder

2021 ◽  
Vol 16 (6) ◽  
Author(s):  
Ashish P Thakrar ◽  
David Furfaro ◽  
Sara Keller ◽  
Ryan Graddy ◽  
Megan Buresh ◽  
...  
Keyword(s):  
Internal Medicine ◽  
Methadone Maintenance ◽  
Internal Medicine Resident ◽  
Opioid Use Disorder ◽  
Hospitalized Patients ◽  
Opioid Use ◽  
Medicine Resident ◽  
Clinician Education ◽  
Engagement In Treatment

BACKGROUND: Hospitalized patients with opioid use disorder (OUD) are rarely started on buprenorphine or methadone maintenance despite evidence that these medications reduce all-cause mortality, overdoses, and hospital readmissions. OBJECTIVE: To assess whether clinician education and a team of residents and hospitalist attendings waivered to prescribe buprenorphine increased the rate of starting patients with OUD on buprenorphine maintenance. DESIGN, SETTING, PARTICIPANTS: Quality improvement study conducted at a large, urban, academic hospital in Maryland involving hospitalized patients with OUD on internal medicine resident services. INTERVENTION: We developed a protocol for initiating buprenorphine maintenance, presented an educational conference, and started the resident-led Buprenorphine Bridge Team of residents and attendings waivered to prescribe buprenorphine to bridge patients from discharge to follow-up. MEASUREMENTS: The percent of eligible inpatients with OUD initiated on buprenorphine maintenance, 24 weeks before and after the intervention; engagement in treatment after discharge; and resident knowledge and comfort with buprenorphine. RESULTS: The rate of starting buprenorphine maintenance increased from 10% (30 of 305 eligible patients) to 24% (64 of 270 eligible patients) after the intervention, with interrupted time series analysis showing a significant increase in rate (14.4%; 95% CI, 3.6%-25.3%; P = .02). Engagement in treatment after discharge was unchanged (40%-46% engaged 30 days after discharge). Of 156 internal medicine residents, 89 (57%) completed the baseline survey and 66 (42%) completed the follow-up survey. Responses demonstrated improved resident knowledge and comfort with buprenorphine. CONCLUSION: Internal medicine resident teams were more likely to start patients on buprenorphine maintenance after clinician education and implementation of a Buprenorphine Bridge Team.

Intensive Stuttering Therapy With Telepractice Follow-up: A Case Study

2011 ◽  
Vol 21 (1) ◽  
pp. 11-21 ◽  
Author(s):  
Farzan Irani ◽  
Rodney Gabel
Keyword(s):  
Case Report ◽  
Therapeutic Intervention ◽  
Intensive Therapy ◽  
Positive Outcome ◽  
Eclectic Approach

This case report describes the positive outcome of a therapeutic intervention that integrated an intensive, residential component with follow-up telepractice for a 21 year old male who stutters. This therapy utilized an eclectic approach to intensive therapy in conjunction with a 12-month follow-up via video telepractice. The results indicated that the client benefited from the program as demonstrated by a reduction in percent stuttered syllables, a reduction in stuttering severity, and a change in attitudes and feelings related to stuttering and speaking.

A Hexagonal (II) Phase Phospholipid Neutralization Assay for Lupus Anticoagulant Identification

1993 ◽  
Vol 70 (05) ◽  
pp. 787-793 ◽  
Author(s):  
Douglas A Triplett ◽  
Linda K Barna ◽  
Gail A Unger
Keyword(s):  
Hemophilia A ◽  
Clinical Laboratory ◽  
Neutralization Assay ◽  
Confirmatory Test ◽  
Specific Factor ◽  
Clinical Settings ◽  
Drug Induced ◽  
Variable Screening ◽  
Routine Clinical Laboratory

SummaryLupus anticoagulants (LAs) are immunoglobulins (IgG, IgM, or both) which interfere with in vitro phospholipid (PL) dependent tests of coagulation (e.g. APTT, dilute PT, dilute Russell Viper Venom Time). These antibodies may be identified in a wide variety of clinical settings. With the exception of heparinized patient samples, the presence of LAs is often the most common cause of an unexplained APTT in a routine clinical laboratory. The diagnosis of LAs is difficult due to variable screening reagent sensitivity and intrinsic heterogeneity of LAs. Recently, Rauch and colleagues have shown human monoclonal hybridoma LAs were inhibited by hexagonal (II) phase PLs. In contrast, lamellar phase PLs had no effect. We have evaluated a new assay system, Staclot LA®, which utilizes a hexagonal (II) phase PL (egg phosphatidylethanolamine [EPE]) as a confirmatory test for LAs. Plasma samples from the following patient populations were studied: LA positive, heparinized, oral anticoagulated, hemophilia A and B, and specific factor inhibitors (factors V, VIII, IX). Unlike previous studies, the LA positive patients were a mixed population including: autoimmune diseases, drug-induced, and post-infection. Our findings confirm the specificity of hexagonal (II) phase PL neutralization of LAs.

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