6 research outputs found
Rheumatoid arthritis onset after COVID-19 infection: a case report
At the end of 2019, coronavirus disease (COVID-19) outbreak is caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV2). Worldwide researchers and physician try to explore the mechanisms of damage induced by virus, they focus on the short-term and long-term immune-mediated consequences induced by the virus infection. Every day discover a new pathological condition induced by virus and new symptoms and disease may occur after recovery from disease. Our case report is 41 years old, Indian lady who presented to our primary health care centre complaining of multiple small hand joints pain, both elbows and knees pain with swelling of them and prolonged morning stiffness, diagnosed seropositive rheumatoid arthritis (RA) (arthritis, positive rheumatoid factor (RF), and X-ray changes) after 1 month recovery from COVID-19 infection. She did not have any joint pain and she had negative RF before COVID-19 infection with no family history of RA
Osteosarcoma of the femur in early adult: a case report
Osteosarcomas are primary malignant tumors of bone that are characterized by the production of osteoid or immature bone by the malignant cells. Osteosarcomas are uncommon tumors. Most articles reveal difficulty in diagnosing osteosarcoma in early stage due to its resemblance to benign lesion. That’s why we prefer to do case report for documentation. Diagnosis of the tumor is important especially in early stages for improving prognosis. This case report is of a 21 years old female who presented at Primary Health Care Centre with swelling above right knee post trauma a month ago. Previously she was diagnosed as Non ossifying fibroma (which is a benign lesion and uncommon to change to malignant lesion) at the same site in 2017.
Impact of opioid-free analgesia on pain severity and patient satisfaction after discharge from surgery: multispecialty, prospective cohort study in 25 countries
Background: Balancing opioid stewardship and the need for adequate analgesia following discharge after surgery is challenging. This study aimed to compare the outcomes for patients discharged with opioid versus opioid-free analgesia after common surgical procedures.Methods: This international, multicentre, prospective cohort study collected data from patients undergoing common acute and elective general surgical, urological, gynaecological, and orthopaedic procedures. The primary outcomes were patient-reported time in severe pain measured on a numerical analogue scale from 0 to 100% and patient-reported satisfaction with pain relief during the first week following discharge. Data were collected by in-hospital chart review and patient telephone interview 1 week after discharge.Results: The study recruited 4273 patients from 144 centres in 25 countries; 1311 patients (30.7%) were prescribed opioid analgesia at discharge. Patients reported being in severe pain for 10 (i.q.r. 1-30)% of the first week after discharge and rated satisfaction with analgesia as 90 (i.q.r. 80-100) of 100. After adjustment for confounders, opioid analgesia on discharge was independently associated with increased pain severity (risk ratio 1.52, 95% c.i. 1.31 to 1.76; P < 0.001) and re-presentation to healthcare providers owing to side-effects of medication (OR 2.38, 95% c.i. 1.36 to 4.17; P = 0.004), but not with satisfaction with analgesia (beta coefficient 0.92, 95% c.i. -1.52 to 3.36; P = 0.468) compared with opioid-free analgesia. Although opioid prescribing varied greatly between high-income and low- and middle-income countries, patient-reported outcomes did not.Conclusion: Opioid analgesia prescription on surgical discharge is associated with a higher risk of re-presentation owing to side-effects of medication and increased patient-reported pain, but not with changes in patient-reported satisfaction. Opioid-free discharge analgesia should be adopted routinely
Mismatch Negativity Responses in Children With a Diagnosis of Childhood Apraxia of Speech (CAS)
Antibody and cellular therapies for treatment of covid-19 : a living systematic review and network meta-analysis
OBJECTIVE
To evaluate the efficacy and safety of antiviral
antibody therapies and blood products for the
treatment of novel coronavirus disease 2019
(covid-19).
DESIGN
Living systematic review and network meta-analysis,
with pairwise meta-analysis for outcomes with
insufficient data.
DATA SOURCES
WHO covid-19 database, a comprehensive
multilingual source of global covid-19 literature, and
six Chinese databases (up to 21 July 2021).
STUDY SELECTION
Trials randomising people with suspected, probable,
or confirmed covid-19 to antiviral antibody therapies,
blood products, or standard care or placebo. Paired
reviewers determined eligibility of trials
independently and in duplicate.
METHODS
After duplicate data abstraction, we performed
random effects bayesian meta-analysis, including
network meta-analysis for outcomes with sufficient
data. We assessed risk of bias using a modification
of the Cochrane risk of bias 2.0 tool. The certainty of
the evidence was assessed using the grading of
recommendations assessment, development, and
evaluation (GRADE) approach. We meta-analysed
interventions with ≥100 patients randomised or ≥20
events per treatment arm.
RESULTS
As of 21 July 2021, we identified 47 trials evaluating
convalescent plasma (21 trials), intravenous
immunoglobulin (IVIg) (5 trials), umbilical cord
mesenchymal stem cells (5 trials), bamlanivimab (4
trials), casirivimab-imdevimab (4 trials),
bamlanivimab-etesevimab (2 trials), control plasma
(2 trials), peripheral blood non-haematopoietic
enriched stem cells (2 trials), sotrovimab (1 trial),
anti-SARS-CoV-2 IVIg (1 trial), therapeutic plasma
exchange (1 trial), XAV-19 polyclonal antibody (1 trial),
CT-P59 monoclonal antibody (1 trial) and INM005
polyclonal antibody (1 trial) for the treatment of
covid-19. Patients with non-severe disease
randomised to antiviral monoclonal antibodies had
lower risk of hospitalisation than those who received
placebo: casirivimab-imdevimab (odds ratio (OR)
0.29 (95% CI 0.17 to 0.47); risk difference (RD) −4.2%;
moderate certainty), bamlanivimab (OR 0.24 (0.06
to 0.86); RD −4.1%; low certainty),
bamlanivimab-etesevimab (OR 0.31 (0.11 to 0.81);
RD −3.8%; low certainty), and sotrovimab (OR 0.17
(0.04 to 0.57); RD −4.8%; low certainty). They did not
have an important impact on any other outcome.
There was no notable difference between monoclonal
antibodies. No other intervention had any meaningful
effect on any outcome in patients with non-severe
covid-19. No intervention, including antiviral
antibodies, had an important impact on any outcome
in patients with severe or critical covid-19, except
casirivimab-imdevimab, which may reduce mortality
in patients who are seronegative.
CONCLUSION
In patients with non-severe covid-19,
casirivimab-imdevimab probably reduces
hospitalisation; bamlanivimab-etesevimab,
bamlanivimab, and sotrovimab may reduce
hospitalisation. Convalescent plasma, IVIg, and other
antibody and cellular interventions may not confer
any meaningful benefit.
SYSTEMATIC REVIEW REGISTRATION
This review was not registered. The protocol
established a priori is included as a data supplement.
FUNDING
This study was supported by the Canadian Institutes
of Health Research (grant CIHR- IRSC:0579001321).
READERS’ NOTE
This article is a living systematic review that will be
updated to reflect emerging evidence. Interim
updates and additional study data will be posted on
our website (www.covid19lnma.com).Medicine, Faculty ofNon UBCPediatrics, Department ofReviewedFacultyResearcherPostdoctoralGraduateOthe
Prophylaxis against covid-19 : living systematic review and network meta-analysis
Objective
To determine and compare the effects of drug
prophylaxis on SARS-CoV-2 infection and covid-19.
Design
Living systematic review and network meta-analysis.
Data sources
World Health Organization covid-19 database, a
comprehensive multilingual source of global covid-19
literature to 25 March 2021, and six additional
Chinese databases to 20 February 2021.
Study selection
Randomised trials of people at risk of covid-19 who
were assigned to receive prophylaxis or no prophylaxis
(standard care or placebo). Pairs of reviewers
independently screened potentially eligible articles.
Methods
Random effects bayesian network meta-analysis
was performed after duplicate data abstraction.
Included studies were assessed for risk of bias using a
modification of the Cochrane risk of bias 2.0 tool, and
certainty of evidence was assessed using the grading
of recommendations assessment, development, and
evaluation (GRADE) approach.
Results
The first iteration of this living network metaanalysis
includes nine randomised trials—six of
hydroxychloroquine (n=6059 participants), one of
ivermectin combined with iota-carrageenan (n=234),
and two of ivermectin alone (n=540), all compared
with standard care or placebo. Two trials (one of
ramipril and one of bromhexine hydrochloride) did
not meet the sample size requirements for network
meta-analysis. Hydroxychloroquine has trivial to no
effect on admission to hospital (risk difference 1 fewer
per 1000 participants, 95% credible interval 3 fewer
to 4 more; high certainty evidence) or mortality (1
fewer per 1000, 2 fewer to 3 more; high certainty).
Hydroxychloroquine probably does not reduce the risk
of laboratory confirmed SARS-CoV-2 infection (2 more
per 1000, 18 fewer to 28 more; moderate certainty),
probably increases adverse effects leading to drug
discontinuation (19 more per 1000, 1 fewer to 70
more; moderate certainty), and may have trivial to no
effect on suspected, probable, or laboratory confirmed
SARS-CoV-2 infection (15 fewer per 1000, 64 fewer
to 41 more; low certainty). Owing to serious risk of
bias and very serious imprecision, and thus very
low certainty of evidence, the effects of ivermectin
combined with iota-carrageenan on laboratory
confirmed covid-19 (52 fewer per 1000, 58 fewer to
37 fewer), ivermectin alone on laboratory confirmed
infection (50 fewer per 1000, 59 fewer to 16 fewer)
and suspected, probable, or laboratory confirmed
infection (159 fewer per 1000, 165 fewer to 144
fewer) remain very uncertain.
Co nclusions
Hydroxychloroquine prophylaxis has trivial to no
effect on hospital admission and mortality, probably
increases adverse effects, and probably does not
reduce the risk of SARS-CoV-2 infection. Because of
serious risk of bias and very serious imprecision, it is
highly uncertain whether ivermectin combined with
iota-carrageenan and ivermectin alone reduce the risk
of SARS-CoV-2 infection.
Systematic review registration
This review was not registered. The protocol
established a priori is included as a supplement.
Readers’ note
This article is a living systematic review that will be
updated to reflect emerging evidence. Updates may
occur for up to two years from the date of original
publication.Medicine, Faculty ofNon UBCPediatrics, Department ofReviewedFacultyResearcherPostdoctoralGraduat