Coronary Artery Disease and Cancer: Treatment and Prognosis Regarding Gender Differences

Cardiovascular disease and cancer remain the leading causes of hospitalization and mortality in high-income countries. Survival after myocardial infarction has improved but there is still a difference in clinical outcome, mortality, and developing heart failure to the disadvantage of women with myocardial infarction. Most major cardiology trials and registries have excluded patients with cancer. As a result, there is only very limited information on the effects of coronary artery disease in cancer patients. In particular, the outcomes in women with cancer and coronary artery disease and its management remain empiric. We reviewed studies of over 27 million patients with coronary artery disease and cancer. Our review focused on the most important types of cancer (breast, colon, lung, prostate) and hematological malignancies with particular attention to sex-specific differences in treatment and prognosis.

Use of Baricitinib in Treatment of COVID-19: A Systematic Review

Objectives To assess the role of baricitinib alone or in combination with other therapies as a treatment for patients with COVID-19. Methods Systematic literature search was conducted in the WHO COVID-19 Coronavirus disease database to find clinical studies on use of baricitinib for treatment of COVID-19 between December 1st 2019 and September 30th 2021. Two independent set of reviewers identified the eligible studies fulfilling the inclusion criteria, and relevant data was extracted and a qualitative synthesis of evidence performed. The risk of bias was evaluated with validated tools. Results A total of 267 articles were found to be eligible after primary screening of title and abstracts. Following assessment of full texts, 19 studies were finally included for this systematic review, out of which 16 are observational, and 3 are interventional studies. Collating the results from these observational and interventional studies, baricitinib used as add on to standard therapy, either alone or in combination with other drugs, was found to have favourable outcomes in moderate to severe hospitalised patients with COVID-19. Furthermore, ongoing trials indicate that drug is being extensively studied across the world for its safety and efficacy in COVID-19. Conclusion Baricitinib significantly improves clinical outcomes in hospitalized patients with COVID-19 pneumonia and further evidence may establish the drug as a standard treatment among such patients. Keywords: Baricitinib, JAK kinase inhibitor, SARS-Cov-2, COVID-19, Clinical outcome, Mortality

Association between Cardiologist Consultation and Mortality of Stable Patients with Elevated Cardiac Troponin at Admission

Elevated cardiac troponin (cTn) showed associations with mortality even in stable patients, but management has not been established. We aimed to investigate whether consultation to cardiologists could reduce mortality of stable patients with cTn elevation at admission. We identified 1329 patients with elevated cTn level at hospitalization from outpatient clinic to any department other than cardiology or cardiac surgery between April 2010 and December 2018. The patients were divided into two groups according to cardiologist consultation at admission. For primary outcome, mortality during one year was compared in the crude and propensity-score-matched populations. In 1329 patients, 397 (29.9%) were consulted to cardiologists and 932 (70.1%) were not. Mortality during the first year was significantly lower in patients consulted to cardiologists compared with those who were not (9.8% vs. 14.2%; hazard ratio (HR), 0.50; 95% confidence interval (CI), 0.35–0.72; p < 0.001). After propensity-score matching, 324 patients were in the cardiologist consultation group and 560 patients were in the no cardiologist consultation group. One-year mortality was consistently lower in the cardiologist consultation group (10.5% vs. 14.6%; HR, 0.58; 95% CI, 0.39–0.86; p = 0.01). Cardiologist consultation may be associated with lower mortality in stable patients with cTn elevation at admission. Further studies are needed to identify effective management strategies for stable patients with elevated cTn.

Frequency of Covid Outcome in Covid Patients with Pre-Existing Different Co-Morbid Conditions

Background: Unexpectedly and unfortunately the end of the year 2019 has proved to be the start of a deadliest era of Coronavirus disease 19. Spread of this lethal disease has remained uninhibited so far. How rapidly it has wrapped up the whole world is dangerously alarming. Aim: To determine frequency of Covid outcome in Covid patients with preexisting different co-morbid conditions. Methods: This descriptive study was conducted from July 2020 to January 2021 in two tertiary care hospital i.e. Services hospital, Lahore (Punjab) and hospital, Quetta (Baluchistan). After ethical approval and informed consent from the patients, data from PCR positive patients was recorded. The demographic parameters, travel or exposure history, duration of stay in the hospital and co morbidities including diabetes, hypertension, stroke and ischemic heart diseases of the patients were collected. Results: In our study, total 124 patients including 84(67.7%) male and 40(32.3%) female. The mean ages was 41.29±20.21 years, mean weight and height 83.46±15.1, 174.2±8.31. 82%patients were discharged, and 42%patients suffered death. Among the patients included in this study, 51(%) patients presented with diabetes, 55(%) patients presented with hypertension, 52% had ischemic heart diseases and 1.6% had stroke. Conclusion: The conclusion of this study, there is a significant impact of pre-existing co-morbidities on Covid outcomes. Thus, it can be inferred that by modifying the comorbidities, positive outcome can be observed Keywords: COVID-19, Risk factors, Outcome, Mortality

Treatment with a DPP-4 inhibitor at time of hospital admission for COVID-19 is not associated with improved clinical outcomes: data from the COVID-PREDICT cohort study in The Netherlands

Purpose Inhibition of dipeptidyl peptidase (DPP-)4 could reduce coronavirus disease 2019 (COVID-19) severity by reducing inflammation and enhancing tissue repair beyond glucose lowering. We aimed to assess this in a prospective cohort study. Methods We studied in 565 patients with type 2 diabetes in the CovidPredict Clinical Course Cohort whether use of a DPP-4 inhibitor prior to hospital admission due to COVID-19 was associated with improved clinical outcomes. Using crude analyses and propensity score matching (on age, sex and BMI), 28 patients using a DPP-4 inhibitor were identified and compared to non-users. Results No differences were found in the primary outcome mortality (matched-analysis = odds-ratio: 0,94 [95% confidence interval: 0,69 – 1,28], p-value: 0,689) or any of the secondary outcomes (ICU admission, invasive ventilation, thrombotic events or infectious complications). Additional analyses comparing users of DPP-4 inhibitors with subgroups of non-users (subgroup 1: users of metformin and sulphonylurea; subgroup 2: users of any insulin combination), allowing to correct for diabetes severity, did not yield different results. Conclusions We conclude that outpatient use of a DPP-4 inhibitor does not affect the clinical outcomes of patients with type 2 diabetes who are hospitalized because of COVID-19 infection.

PROTOCOL: A cohort study examining the association between mirtazapine and mortality risk in adults with a diagnosis of depression

ABSTRACTThis protocol describes a cohort study comparing the risks of mortality and serious self-harm (suicide or near-fatal deliberate self-harm) between adults with depression prescribed mirtazapine, a selective serotonin reuptake inhibitor (SSRI), amitriptyline, or venlafaxine. The study is set within English primary care electronic health records from the Clinical Practice Research Datalink (CPRD) and covers the period 01 January 2005 – 30 November 2018. The study described uses an active comparator new user design: patients are included if they are first prescribed an SSRI before being prescribed mirtazapine, a different SSRI, amitriptyline, or venlafaxine as their second antidepressant. Patients are followed from the initial prescription for the second antidepressant until an outcome (mortality, serious self-harm), end of CPRD follow-up, or study end. Inverse probability of treatment weighting is used to account for confounding variables. The protocol was submitted to the CPRD Independent Scientific Advisory Committee for review and was approved in November 2019 (protocol number 19_241).

Retrospective Hospital-Based Cohort Study on Risk Factors of Poor Outcome in Pediatric Snake Envenomation

Background and Objectives Among Southeast Asian countries, India has reported the highest mortality due to snakebite envenomation. To identify the risk factors of poor outcome (mortality/mechanical ventilation/renal replacement therapy—RRT) in pediatric snakebite envenomation. Method Case records of children aged less than 13 years with snakebite envenomation admitted between June 2009 and July 2015 were reviewed retrospectively. Medical records of the patient died within 6 h, those required RRT before administration of antisnake venom (ASV), and those with unknown bites were excluded. Results A total of 308 patients were included. One hundred eighty (58.4%) had hemotoxic, and 128 (41.6%) had neuroparalytic envenomation. Median (interquartile range) bite to ASV time was 3 (2–6) h. Seventy-five (24.4%) patients received ASV within 6 h of bite. Poor outcomes occurred in 128 (41.6%), and 36 (11.7%) patients died. On binary logistic analysis (adjusted odds ratio, 95% confidence interval), age ≤5 years (2.97, 1.28–6.90), walking (6.15, 2.88–13.17), playing (3.36, 1.64–6.88), no tourniquet (2.39, 1.25–4.57), time to ASV more than 6 h (2.71, 1.45–5.06), fang marks (2.22, 1.21–4.07), neurotoxic envenomation (3.01, 1.11–8.13) and additional ASV dose (8.41, 2.99–23.60) were independently predicted the poor outcome (Hosmer and Lemeshow goodness of fit model p = 0.135; overall percentage of the model is 72.2% and R-square = 0.28). Conclusion Age below 5 years, activity at/after the bite (playing/walking), no tourniquet, a longer bite to ASV time, presence of fang marks, neurotoxic envenomation and need for additional ASV dose were independent predictors of poor outcome in pediatric snakebite envenomation.

Association of Obstructive Sleep Apnea and severity of COVID-19: A hospital based observational study

IntroductionOSA has been postulated to be associated with mortality in COVID19, but studies are lacking thereof. This study was done to estimate prevalence of OSA in patients with COVID-19 using various screening questionnaires and to assess effect of OSA on outcome of disease.MethodologyIn this prospective observational study, consecutive patients with RTPCR confirmed COVID 19 patients were screened for OSA by different questionnaires (STOPBANG, Berlin Questionnaire, NoSAS and Epworth Scale). Association between OSA and outcome (mortality) and requirement for respiratory support was assessed.ResultsIn study of 213 patients; screening questionnaires for OSA {STOPBANG, Berlin Questionnaire (BQ), NoSAS} were more likely to be positive in patients who died compared to patients who survived. On binary logistic yregression analysis, age≥55 and STOPBANG score ≥5 were found to have small positive but independent effect on mortality even after adjusting for other variables. Proportion of patients who were classified as high risk for OSA by various OSA screening tools significantly increased with increasing respiratory support (p<0.001 for STOPBANG, BQ, ESS and p=0.004 for NoSAS).ConclusionThis is one of the first prospective studies of sequentially hospitalized patients with confirmed COVID 19 status who were screened for possible OSA. This study shows that OSA could be an independent risk factor for poor outcome in patients with COVID19.

Dementia in old age: from diagnosis to fatal outcome

Background: It is well known, that old age dementias steadily grow progressively worse and inevitably lead to fatal outcome. Mortality indices in foreign research largely vary, they are practically absent in domestic scientific studies, and official statistical data on the prevalence of dementia and the cause of death do not reflect the real situation. The Objective of the study was to perform the analysis of completed cases of late age dementias from the materials of observations in Alzheimer’s disease center of the Mental Health Research Center.Patients and Methods: Observational study, using prospective method of out-patient observation of subjects with dementias, who consulted Alzheimer’s disease center in 2007-2016 for the first time, made it possible to obtain reliable data on 217 patients, who died during this period.Results: More than one third of such cases (39%) referred to nosologically various dementias with an early onset of the disease. In more than half of the cases (58%) the cause of death was medical pathology. In the rest of the patients severe or terminal stage of the basic disease was noticed toward the end of life under conditions of home care.Conclusions: Holistic view of the clinical picture of old age dementias (from the onset of the disease till the fatal outcome) is necessary for creation of incidence registers and obtaining of science-based statistical indices of survival, mortality and causes of death. It is necessary to develop measures of assistance to families of patients with the most severe stage of dementias, creation of out-patient and in-patient network of hospices for this contingent of patients.

Effects of effective acute anti-hypertensive therapy on ischemic stroke prognosis: a meta-analysis of randomized controlled trials

Background: Although multiple randomized controlled trials (RCTs) and meta-analyses have been conducted on the issue of acute phase anti-hypertensive therapies for ischemic stroke (IS) patients, many studies have failed to enhance blood pressure (BP) decrease after these treatments. The effects of effective acute anti-hypertensive therapies on IS prognosis are still unclear.Methods: Published literature was systematically searched in PubMed, Embase and Cochrane Library. Multiple RCTs that included IS patients, in which there was a significant BP decrease in the anti-hypertensive intervention group compared with the control group within 72 h after the onset of stroke, were identified. A meta-analysis was conducted to assess the effects of such therapy on the functional outcome, mortality, and multiple severe adverse events (SAEs) of IS patients.Results: Eight RCTs were included in this study, with a total of 9427 IS patients. According to this meta-analysis, with significant BP differences between the treatment and control groups within 72 h from stroke onset, effective acute anti-hypertensive therapy has a neutral effect on multiple IS prognostic factors, including functional outcome (RR 1.03, 95% CI 0.93-1.13), mortality (RR 1.10, 95% CI 0.89-1.35), and multiple SAEs.Conclusions: Based on current studies, effective acute anti-hypertensive therapy did not improve the prognosis of IS patients, including functional outcome, mortality, and SAEs. There is no evidence that such therapy is beneficial in clinical practice.