Mortality Benefit
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2021 ◽  
Anoop Amarnath ◽  
Ananya Das ◽  
Venkata Sai Shashank Mutya ◽  
Irfan Ibrahim

Introduction: Coronaviruses typically cause influenza like illness which progresses to ARDS along with other systemic manifestations. India is experiencing its second wave with a huge surge in the number of cases exponentially causing huge impact on health care infrastructure and the demand supply chain. As a result several new modalities have been used, one of which is the use of remdesivir and baricitanib. Hence this study is aimed at finding out the clinical and biochemical profile of the patients who have received the combination Materials and Methods: All the patients who have received the combination meeting the inclusion and exclusion criteria have been included in the study. A total of 31 participants were included and their records were retrospectively analyzed. Results: There was a significant reduction in the oxygen requirement, CRP and IL-6 levels with p values<0.05. However, in the non-survivors group, there was no statistically significant reduction. Serial monitoring of NLR ratio showed increase towards the fifth day, especially in the non-survivor group it was as high as 41.24. The mortality rate was found to be 10% and the cause being secondary sepsis in all of them. Conclusion: The ACTT-2 trail has proved the efficacy of the use of the remdesivir and baricitanib combination with mortality benefit. In our study we found similar results which was well co-related with clinical and biochemical parameters like CRP and IL-6 especially in people with co-morbidites.

2021 ◽  
Vol 8 (1) ◽  
pp. e000863
Robert C Free ◽  
Matthew Richardson ◽  
Camilla Pillay ◽  
Kayleigh Hawkes ◽  
Julie Skeemer ◽  

BackgroundA specialist pneumonia intervention nursing (SPIN) service was set up across a single National Health Service Trust in an effort to improve clinical outcomes. A quality improvement evaluation was performed to assess the outcomes associated with implementing the service before (2011–2013) and after (2014–2016) service implementation.ResultsThe SPIN service reviewed 38% of community-acquired pneumonia (CAP) admissions in 2014–2016. 82% of these admissions received antibiotic treatment in <4 hours (68.5% in the national audit). Compared with the pre-SPIN period, there was a significant reduction in both 30-day (OR=0.77 (0.70–0.85), p<0.0001) and in-hospital (OR=0.66 (0.60–0.73), p<0.0001) mortality after service implementation, with a review by the service showing the largest independent 30-day mortality benefit (HR=0.60 (0.53–0.67), p<0.0001). There was no change in length of stay (median 6 days).ConclusionImplementation of a SPIN service improved adherence to BTS guidelines and achieved significant reductions in CAP-associated mortality. This enhanced model of care is low cost, highly effective and readily adoptable in secondary care.

2021 ◽  
Vol 2 (3) ◽  
pp. 264-273
Yeung Jek Ho ◽  
Audrey Su-Min Koh ◽  
Zhi Hao Ong ◽  
Cheng Han Ng ◽  
Gwyneth Kong ◽  

(1) Background: Treatment of dyslipidemia via statin therapy in the non-liver transplant (LT) population is associated with a mortality benefit; however, the impact of statin therapy in post-LT population is not well-defined. This meta-analysis seeks to investigate the safety and efficacy of statin therapy in post-LT patients. (2) Methods: A systematic literature search on Medline and EMBASE database was conducted. A single-arm proportional meta-analysis and conventional pair-wise meta-analysis were performed to compare different outcomes with a random effects model. (3) Results: A total of 11 studies were included in this study, with 697 LT recipients identified to be on statin therapy. Statins were underutilized with only 32% (95% CI: 0.15–0.52) of 1094 post-LT patients on therapy. The incidence of adverse events of 14% (95% CI: 0.05–0.25) related to statin therapy was low. A significant mortality benefit was noted in patients on statin therapy with HR = 0.282 (95% CI: 0.154–0.517, p < 0.001), and improved lipid profiles post LT. The use of statins also significantly decreased odds of graft rejection (OR = 0.33; 95% CI: 0.15–0.73) and hepatocellular carcinoma (HCC) recurrence (HR = 0.32, 95% CI: 0.11–0.89). (4) Conclusions: Statin therapy is safe and efficacious in post-LT patients. Future studies to evaluate the effects of interactions between statins and immunosuppressant therapy are warranted.

Michael A. Puskarich ◽  
Theodore S. Jennaro ◽  
Christopher E. Gillies ◽  
Charles R. Evans ◽  
Alla Karnovsky ◽  

2021 ◽  
Vol 78 (1) ◽  
pp. 14-23 ◽  
John W. Eikelboom ◽  
Deepak L. Bhatt ◽  
Keith A.A. Fox ◽  
Jacqueline Bosch ◽  
Stuart J. Connolly ◽  

2021 ◽  
pp. 000313482110249
Leonardo Alaniz ◽  
Omaer Muttalib ◽  
Juan Hoyos ◽  
Cesar Figueroa ◽  
Cristobal Barrios

Introduction Extensive research relying on Injury Severity Scores (ISS) reports a mortality benefit from routine non-selective thoracic CTs (an integral part of pan-computed tomography (pan-CT)s). Recent research suggests this mortality benefit may be artifact. We hypothesized that the use of pan-CTs inflates ISS categorization in patients, artificially affecting admission rates and apparent mortality benefit. Methods Eight hundred and eleven patients were identified with an ISS >15 with significant findings in the chest area. Patient charts were reviewed and scores were adjusted to exclude only occult injuries that did not affect treatment plan. Pearson chi-square tests and multivariable logistic regression were used to compare adjusted cases vs non-adjusted cases. Results After adjusting for inflation, 388 (47.8%) patients remained in the same ISS category, 378 (46.6%) were reclassified into 1 lower ISS category, and 45 (5.6%) patients were reclassified into 2 lower ISS categories. Patients reclassified by 1 category had a lower rate of mortality ( P < 0.001), lower median total hospital LOS ( P < .001), ICU days ( P < .001), and ventilator days ( P = 0.008), compared to those that remained in the same ISS category. Conclusion Injury Severity Score inflation artificially increases survival rate, perpetuating the increased use of pan-CTs. This artifact has been propagated by outdated mortality prediction calculation methods. Thus, prospective evaluations of algorithms for more selective CT scanning are warranted.

2021 ◽  
Vol Publish Ahead of Print ◽  
Amisha P. Mehta ◽  
Kevin Wissman ◽  
Amy J. DiPlacido

BMJ Open ◽  
2021 ◽  
Vol 11 (6) ◽  
pp. e048416
Surjit Singh ◽  
Daisy Khera ◽  
Ankita Chugh ◽  
Pushpinder Singh Khera ◽  
Vinay Kumar Chugh

ObjectivesEvaluation of remdesivir, an RNA polymerase inhibitor, for effectiveness in adults with COVID-19.Data sourcesElectronic search for eligible articles of PubMed, Cochrane Central and was performed on 20 September 2020.Participants and study eligibility criteriaOnly randomised controlled trials (RCTs) evaluating efficacy of remdesivir in COVID-19 were included for meta-analysis.InterventionsRemdesivir was compared with standard of care.Primary and secondary outcomesPrimary outcome was mortality and secondary outcomes were time to clinical improvement and safety outcomes like serious adverse events, respiratory failure.Study appraisal and synthesis methodsData synthesis was done with Cochrane review manager 5 (RevMan) V.5.3. Cochrane risk of bias V.2.0 tool was used for methodological quality assessment. The GRADE pro GDT was applied for overall quality of evidence.Results52 RCTs were screened and 4 studies were included in analysis, with total of 7324 patients. No mortality benefit was observed with remdesivir versus control group (OR=0.92 (95% CI 0.79 to 1.07), p=0.30, moderate quality evidence). Significantly higher rates of clinical improvement (OR=1.52 (95% CI 1.24 to 1.87), p<0.0001, low quality) and faster time to clinical improvement (HR=1.28 (95% CI 1.12 to 1.46), p=0.0002, very low quality) was observed with remdesivir versus control group. Significant decrease was found in the risk of serious adverse events (RR=0.75 (95% CI 0.62 to 0.90), p=0.0003, low quality); however, no difference was found in the risk of respiratory failure (RR=0.85 (95% CI 0.41 to 1.77), p=0.67, very low quality evidence) with remdesivir.ConclusionsAs per the evidence from current review, remdesivir has shown no mortality benefit (moderate quality evidence) in the treatment of COVID-19. From a cost–benefit perspective, it is our personal opinion that it should not be recommended for use, especially in low and lower middle income countries.Trial registration numberPROSPERO registration number: CRD42020189517.

The COVID-19 global pandemic has resulted in more than 118 million cases and more than 2.5 million deaths. Most fatalities are related to severe pulmonary disease caused by a severe inflammatory response to the virus in the lungs. As yet there is no uniformly successful therapeutic agent. Tocilizumab is a monoclonal antibody that binds to IL-6 receptor thus inhibiting IL-6 mediated signaling of the inflammatory cascade. Early trials did not show a mortality benefit in patients treated with this agent. Newer studies have shown a benefit when Tocilizumab is used in conjunction with corticosteroids. This is a brief report on 7 patients with severe COVID-19 infection who received Tocilizumab therapy at our community hospital in the early period of the pandemic.

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